Why We Love Abraham Verghese

October 25, 2012

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.


{ 11 comments }

Jody Schoger October 25, 2012 at 6:55 pm

Thanks for writing about this, Bryan. Verghese’s talk stayed with me. I found it impossible to forget the dueling images of doctors huddled around computer screens as opposed to”gentler” times when doctors gathered around a living, breathing patient.

My perspective is understandably different. I think part of Verghese’s relevance is his emphasis on the human element in the exchange; where touch is evolving along with technology. Touch can be the skill inherent in a physician listening and interpreting; and a patient’s skill and willingness to articulate symptoms, concerns and issues. If we ever reach the point where technology and data circumvent the relationship itself then we will have all collectively failed. Technology is a means to an end, a way to empower health, and not the other away around.

Thanks again. Your post encouraged me to reviw my notes from that talk, and far from surrending empowerment issues, Verghese’s work and words at Stanford enforced how critical they really are.

Jody

DrV October 26, 2012 at 12:37 pm

Diagnostically, between a machine that can tell me precisely what’s going on and a gentle guessing human, I’ll take the machine.

When it comes to understanding and processing, I’ll take the gentle human.

Touch is key. But increasingly its after the machines have helped us understand.

Steve Levine October 26, 2012 at 10:54 am

Thanks, as always, for reminding us about Dr. Verghese’s unique insights into medicine and, well, people. We are excited to announce that he will be the keynote General Session speaker at our annual meeting next year, TexMed2013 in San Antonio, May 17-18.

DrV October 26, 2012 at 10:58 am

Wowza. Maybe I’ll have to make the trip! He’s speaking next week at the AAMC in San Francisco.

Redstone October 26, 2012 at 11:51 am

I believe I saw Abraham give a talk about how disconnected we are from our patients. And it sounds politically correct and great in the academic world to say that like in the political world it is excellent to talk about veterans. But in reality I think the issue is not the physicians it is the system. It is all well and good for an academian (a infectious disease doc at that) to voice what he or she says is the power of touch or the power of being with the patient, but they leave out something called the real world of medicine. Ask any family practitioner or pediatrician if they would like to spend 45 minutes sessions with their patients and they would all say yes, but that is a fiscal impossibility. No one will disagree that it is important to hone our skills or the power of touching a patient, but I would like to see Abraham practice in Louisville, Gainesville, Appleton, and every other non-academic setting in the country to try and maintain the schedule of 45 minute patient visits.

It’s nice being a consultant because you lose touch of the all the nitty-gritty work it takes to get a patient to see a specialist. I hope Abraham enjoys his 15 minutes, but the changes need to happen on a systemic level for change in health care to occur. This is what doctor’s should advocate for. We probably don’t need Obamacare entirely, but we do need basic preventative coverage for all Americans. This is more important then the nostalgia of when we could spend an hour with every patient.

Carolyn Thomas October 26, 2012 at 12:08 pm

When Dr. Verghese tells his TED audience: “If you come to one of our hospitals missing a limb, nobody will believe you unless they get a CATscan, MRI or orthopedic consult”, he’s kidding. I think.

But even more than a doctor’s physical touch, the “patient encounter” that many of us patients miss is common courtesy. You know, things like eye contact. Saying ‘Hello” when you enter the patient’s room. Introducing yourself. Explaining what’s about to happen, and asking if there are questions. You would be gobsmacked to know how often these courtesies simply do not happen.

When I was lying in the E.R. in mid-heart attack, I overheard the doctors and nurses outside the curtains of my little cubby referring to me as “the M.I. in Bed 8″. For far too many health care professionals, that’s about the size of it. And now their emerging tech-infatuation merely threatens to increase the distance between humanity and technology.

Sigh…

DrV October 26, 2012 at 12:30 pm

I’m not sure he’s kidding. In my community, many children presenting to an ER with abdominal pain are likely to get a CT scan before ever being touched by a clinician. Technology is replacing alot of what we used to do with our hands.

Touch will find its way back, but likely not to diagnose.

Kathy Mackey October 26, 2012 at 4:29 pm

I was fortunate to have seen Dr Verghese at the University of Houston for a book signing and fireside chat last year. The audience listened and laughed while he shared childhood memories that helped us understand him as an author and physician.

As we waited for our books to be signed, Dr Verghese connected with each of us in a way we’ll never forget. I’ve been fortunate to have been exposed to many dedicated-doctors. The good news I think, is that not everyone can be a patient of Dr Verghese, but they can read Cutting for Stone, listen to his word and be inspired by his message no matter where they are. Raising the voice of inspiring physicians makes a difference.

Dr George Margelis October 26, 2012 at 9:57 pm

I too had the pleasure of seeing Dr Varghese last year at Stanford at Medicine 2.0. He refers to supposedly good times when we could sit and hold our patient’a hand and share our empathy. Unfortunately I think his memory may be limited to his time as a senior physician at Stanford with a self selected group of patients, and isolated from the supply and demand pressures the rest of the healthcare system has been exposed to over the last decade.
My colleagues and I share his desire to spend more time with our patients, but we also have a strong desire to help them get better and get back home. We need to make room for the next batch of patients already waiting in our emergency department to be treated and if needed to be admitted to our wards.
My colleagues in ambulatory care would love to spend more time with our patients as well, but to do so we would need to increase the co pay to cover our practice costs, or work even longer hours.
Along comes some smart folk with some new technology that has the potential to improve our outcomes, but in the process we need to spend some of our time in front of a screen to make it work. The problem is the hospital has bought a bunch of old large stationary desk top computers, because they are cheaper than the more mobile laptops and tablets, and stuck them all in a room down the other side of the ward. So we trudge off to them to try and make sure we provide safe high quality care for our patients. We have read the report from the IOM which tells us we have killed thousands of patients because of our well meaning but alas dangerous practices in the past, and hope that this new technology will help us avoid this in the future.
In an ideal world we could do both, but we don’t so we try and do the best we can. It is overly simplistic to blame the technology for the supposed loss of the personal touch in healthcare. Nothing is that simple unfortunately in the complex world of healthcare. I applaud Dr Varghese’a passion for a simpler time, but with an ever expanding pool of patients and dwindling resources the reality is we do not always have that luxury.

Chris Johnson October 27, 2012 at 12:59 pm

I don’t think it’s either/or and I’m optimistic. I’ve practiced pediatric critical care for 30 years and I’ve come to realize what I do is really family practice, just with fancy stuff surrounding me that goes bing-bing .

Technology doesn’t stop you from being whatever kind of physician you want to be.

Dr George Margelis October 27, 2012 at 4:48 pm

You are right Chris, it is a combination of both, and something for the individual doctor to choose based on their own skills and desires. My point is that it also needs to be understood within the constraints of the system under which we work. We now have access to information systems that have the potential to significantly benefit our patients, so it would be criminal for us not to use them. At present the interface between those systems and the way we practice medicine is not perfect, but we are used to working with imperfect systems. We do what we need to do to make it work today, and then try and develop better systems for the future. Spending time lamenting an earlier simpler time is counterproductive. Working on a solution that enables doctors to sit by the bedside, talk to their patients, and access the relevant information in a “meaningfully useful” way is what we should be concentrating on.

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