A Professor at Stanford, Abraham Verghese believes that physicians have strayed too far from the patient. We’ve become wrapped up in numbers and machines such that we’ve lost sight of the patient.
I admit to being captivated by Verghese’s message. I heard him speak at Stanford’s Medicine 2.0 in 2011 where he discussed the ritual of contact between the doctor and patient. Before a backdrop of images immortalizing Corvisart, Auenbrugger and Laennec, he detailed the exam process and human response in the most compelling terms. The audience was enraptured. Medical educators swooned. Students dreamt of how good it could be. Patient advocates all but surrendered their quest for empowerment and independence. At the end we all wanted to be taken care of in some Victorian kind of way. We wanted to be touched – Either by Verghese himself or one of those stern, dangerously intelligent grey haired gentlemen depicted in his canvas projections.
We all want a piece of what Verghese sells. But can we have it? Or is this is a beautiful fantasy?
At one point the patient encounter was a transformational ritual. This ritual took place at time when the doctor’s hand served as the final word in understanding a problem. This is no longer the case. We can mimic the ritual. We can talk about how it once was. But in the face of modern diagnostics, the ritual has a different meaning. The exam emerges more transactional than relational.
This is a terrifying reality for me as a physician. I was trained in the spirit of DeBakey and Osler. I was taught to be the man in the painting. Now I work to keep pace with a field shifting so quickly that few of us can really understand.
I suspect that over the coming generation touch will assume a new kind of relevance in the patient encounter. No less important than it once was, just different. This materializing role of touch deserves real dialog by students and teachers.
Perhaps it’s our penchant for the past that accounts for our love of Abraham Verghese.
Verghese, it seem, has an obligation to remind us of how it once was. Others have an obligation to think how it might be.