Practicing Humanism in Medicine With Dr. Abraham Verghese

Robert Harrington, MD; Abraham Verghese, MD

Disclosures

March 06, 2013

In This Article

Editor's Note:
As technologies advance, has the art of bedside medicine been lost? Abraham Verghese, MD, renowned author of Cutting for Stone as well as other popular books, talked with Robert Harrington, MD, about the role of humanism in medicine. This is a condensed transcript of the podcast of their conversation, which first appeared on Medscape's sister site theheart.org.

Dr. Harrington: Hi. My guest today is Abraham Verghese, who is a professor here at Stanford University. Abraham is an infectious disease (ID) specialist by training who now spends much of his time in general internal medicine, largely in a hospital-based practice. I'd like to pick his brain a bit on the role of humanism in medicine, and particularly talk about something that's very important to Abraham: the training of medical students and residents.

In cardiovascular medicine, most of us really focus on the technical part of our job -- the imaging, the stress testing, the cath, the MRI, the CT -- but it's really a field that evolved at the bedside, listening to the heart and thinking about what we're hearing. It's a field that evolved from the importance of the patient history, the description of chest pain, the original classic descriptions of angina pectoris. All of these have been very important, but they often are lost in this massive technology we have.

Dr. Verghese: I think it's important to keep our feet rooted in the history of this wonderful profession, and I like the expression that Robert Loeb used many years ago. He spoke about the Samaritan function of being a physician. In other words, there's much more to what we do than simply finding the biology of disease and administering a cure. We're dealing with human beings who are not just biological machines, but who have deep and complex feelings. I think the humanistic aspect of medicine is trying to address just that: the need for not just a cure, but also healing.

A nice analogy that I use with my students is, if you were to go to your house after a day's work and find that your door is open, your lock is in splinters, and all your valuables are gone, you'd be devastated. You would have suffered a physical loss. But you would have also suffered a sort of violation. Someone has come into your sacred space and broken the trust and taken your things. Then, let's say the police come by an hour later and say, "We found the person who did this, and here's all your stuff back." At that point you will be cured, but you will not be healed. Your sense of having been violated will be so strong that you might actually leave that house or apartment. It will somehow not be the same for you.

I think we forget that for most patients, illness has both of those aspects. There's always a physical sense of loss, but there's also always a sense of spiritual violation: a sense of "why me, why now?" I think part of our fiduciary responsibility in medicine, part of our fulfilling the public trust, is to address both the physical loss and the sense of violation. That is where humanism in medicine comes into play. It is a reminder that we are there to minister to more than just the body, but also to the soul.

Dr. Harrington: That's a wonderful analogy. Abraham, much of what you do here at Stanford is teaching. I know it's very important to you. How do you see your role as an academic physician, and how do you approach the role of the teacher?

Dr. Verghese: The thing about teaching, as you know, is that it teaches you. You have to learn in order to teach. I think it keeps us all fresh. But I find that I also enjoy the ritual of teaching -- the fact that I wind up repeating some things every few months as another crew of students comes through, and I find myself saying the same things. I have a new appreciation for some of my professors and the enthusiasm with which they taught me. I'm always reminded that for every student, my interaction should feel like it is a first time and not convey any sense of being jaded.

If we do it right, teaching one person over a lifetime will influence so many other people. It's a huge responsibility, because you can leverage your teaching into someone's actions in a way that can make a difference to thousands of others. So I take it very seriously, and I also get a great deal of pleasure from it.

I think what has happened in the past couple of years is a growing sense that these bedside skills are in jeopardy. And if we don't urgently teach them and convey them, we are in great danger of turning out graduates who are really no more than robots. They're very good at data and the latest this and that, but we want them to make the sort of observations that are still more valuable than genomics. If someone walks into the clinic with an outline of a cigarette package in his front shirt pocket, we already know much more about his future and his cardiac risk than almost anything else you could get from him. It would be a shame to miss that simple observation. That is what excites me now, trying to convey those skills.

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