Notes From A Talk by Abraham Verghese
On Friday, I had the privilege of attending a talk by Abraham Verghese hosted by the larger workplace for its Abraham Flexner lecture. Verghese is the author of “My Own Country,” a book chronicling his work as a physician tending to AIDS patients in the early days in East Tennessee. I just read “My Own Country” recently, and was particularly intrigued by it because I was a kid growing up in a town mentioned in the book at the time Dr. Verghese was practicing there. I remember the kinds of misconceptions many still had about AIDS a decade after the period he covers, and I can imagine what the environment must have been like for his work and his patients.
Friday’s talk was titled, “Touching Where it Hurts: The Role of Bedside Examination in a Technological Age.” Dr. Verghese spoke about the history of bedside diagnosis, including devices used by physicians in the physical exam and the origins of percussion as a diagnostic tool. He also spoke briefly on the shift toward technology and away from the bedside, mentioning that he had gotten in a bit of trouble for referring to the patient in the bed as almost an icon for the real patient in the computer.
The central point of Verghese’s talk, then, was the importance of touch and attention and interaction in the approach to the patient. He began with a story about a woman diagnosed with breast cancer who received some of the best available care in one of the best available environments (a prominent cancer center), but who returned to her private oncologist because of a perception that the bi cancer center never actually or adequately examined her breasts. Dr. Verghese noted that there was almost no diagnostic need to examine the woman’s breasts,g iven the samples and scans available to the team, but that the physical examination played an important role for the woman in her satisfaction with the care she was receiving.
I was particularly interested when Dr. Verghese spoke about the importance of rituals, including the ritual of one individual (the patient) seeking another (the provider), telling a story, disrobing, and allowing touch. He called it a ritual of tremendous significance, and urged providers to make sure that their skills at examination were equal to that ritual. He also spoke of a difference between curing and healing, noting that physicians can help to heal the sense of violation of an injury or illness by engaging at the patient bedside.
This short recap can’t really do the talk justice – several other interesting comments were made and stories told in the lecture. Dr. Verghese also read a very amusing passage about performing vasectomies from his most recent book, Cutting for Stone. His books are (in reverse chronological order with links to find them in libraries): Cutting for Stone, The Tennis Partner: A Doctor’s Story of Friendship and Loss, and My Own Country.