By RENEE STOVSKY
In Dr. Abraham Verghese's novel, Cutting for Stone, Dr. Thomas Stone, a renowned surgeon, poses this question to an audience of 200 medical students: "What treatment in an emergency is administered by ear?"
"Words of comfort," answers internist Marion Stone, the surgeon's estranged son and the book's protagonist.
Though the 2009 best seller is a work of fiction, Verghese draws upon his own past to spin his tale of both life in Emperor Haile Selassie's Ethiopia and his beliefs about the practice of medicine. Chief among those beliefs is that physicians need to show empathy toward their patients.
"We are at a unique juncture in medicine. We have phenomenal technologies and therapies to address diseases, yet paradoxically, the public is becoming more disenchanted with medical care," says Verghese, the Linda R. Meier and Joan F. Lane Provostial Professor and vice chair for the theory and practice of medicine at Stanford University School of Medicine. "We need to see patients as human beings who are suffering, fearful and in need of not just treatment but comfort and reassurance."
Verghese will be the closing speaker at the Catholic Health Assembly in Chicago.
Verghese's vision for the future of health care — one that marries technological innovation with the traditional doctor-patient relationship — is one that has been honed over many years, in his roles as medical student, physician, academic and author.
Medicine and writing
Born in 1955 in Ethiopia's Addis Ababa to Indian parents — physicists who were recruited by Selassie to teach in Ethiopia — Verghese began his medical training in East Africa but came with his family to the United States when the emperor was deposed in 1974. After working as an orderly here, he completed his medical degree at Madras Medical College in India, then worked as an internal medicine resident in Johnson City, Tenn., from 1980-1983.
From there, Verghese received a fellowship at Boston University School of Medicine, and worked at the former Boston City Hospital for two years, where he saw early signs of the HIV/AIDS epidemic. After that, he returned to Johnson City as an assistant professor of medicine at East Tennessee State University, and found rural communities had not been spared from what was then an incurable disease. By caring for terminally ill patients, Verghese says, he learned the subtle difference between curing and healing.
Next, to pursue his growing interest in a literary career, Verghese attended the Iowa Writers Workshop at the University of Iowa, where he received a master's degree in fine arts in 1991.
He returned to medicine after that, becoming a professor and chief of the division of infectious diseases at Texas Tech University Health Sciences Center in El Paso, where he lived for 11 years. His first book, My Own Country: A Doctor's Story, about his experiences in Tennessee, was published in 1994 and chosen as a Best Book of the Year by Time magazine. His second book, The Tennis Partner: A Doctor's Story of Friendship and Loss, is another memoir. In it, Verghese explored the destructive force of addiction, telling the story of his relationship with a charismatic medical student, a gifted athlete who became Verghese's regular tennis teacher and opponent. It was listed as a New York Times Notable Book in 1998.
In 2002, Verghese became founding director of the Center for Medical Humanities and Ethics at the University of Texas Health Science Center in San Antonio. He joined Stanford University in 2007 as tenured professor for the theory and practice of medicine and associate chair of internal medicine. In 2009, Cutting for Stone was published; it remained on The New York Times best-seller list for more than two years, selling more than a million copies.
These days, Verghese continues to pursue both his deep interest in bedside medicine and his writing career. Among his many duties at Stanford, he directs the third-year medical student clerkship at Stanford Hospital. He is also working on a much-anticipated new novel, The Maramon Convention, slated for release in 2015.
iPatient
Throughout Verghese's many career transitions, the common thread of his life's work has been an abiding belief in medicine as a human transaction — a notion he fears is being replaced by faith placed in diagnostic tools such as CT scans, MRIs and ultrasounds.
"I often tell my medical students that I wonder what an alien would think if he found his way to a hospital, hid in a corner of a ward for internal medicine care and observed the proceedings," he says. "Instead of seeing a doctor talking to his patient and touching him or her where it hurts, he might come to the conclusion that the bedside is toxic — a place everyone avoids in favor of digital machines that can render a 3-D human into a 2-D image."
Indeed, in Palo Alto, Calif., Verghese might be considered something of a heretic for his coinage of the term "the iPatient."
"Living as I am in Silicon Valley, I am certainly not a Luddite when it comes to the use of highly advanced tools to help in the treatment of patients, but I fear we have lost sight of the proper use of technology and turned the patient in the bed into an icon for the patient in the computer," he says.
"The power of the human hand to diagnose and treat disease at its earlier stages cannot be overlooked. And I fear that the increase in diagnostic testing tools goes along with decreased skill in bedside diagnosis."
Healing ritual
In fact, Verghese goes so far as to call the bedside exam a "ritual."
"According to my colleagues in the anthropology department at Stanford, a ritual is about transformation," he says. "In this case, it is about validating the personhood of the patient, locating the illness on the body, and making an affirmation of connection, commitment and trust."
The medical exam, he adds, has all the "trappings" of a ritual — with a dedicated space, special furniture, the doctor in a ceremonial white robe, the patient in a paper robe, the traditional manner in which the exam takes place. To shortchange that is to shortchange the essential pact between patient and physician, he believes.
And that pact is transcendent. It is the message, Verghese says, that is necessary to the patient and cathartic to the physician. "A doctor needs to convey the idea that 'I will always, always be there. I will be with you through the end. I will never abandon you,'" he says.
That message, he adds, can actually act as a placebo. "Given in a certain context, with the proper tone of voice, it can have profound neurobiological effects," he says.
Power of touch
And despite the emphasis of modern health care on discussions of data, electronic medical records and reimbursements — much of which has made doctors lose sight of the power of touch in patient care — Verghese believes the pendulum is swinging back toward the art of medicine.
"America's aging population does not need fee-for-service care. Ninety-year-old patients need personal, humanistic care — someone to listen to them and make sure they understand how and when to take their medicines," he says. Those providers, he adds, can be primary care physicians but also "physician extenders" — nurse practitioners, dieticians, physical therapists and more.
Simply put, "patients want caregivers," Verghese says.