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Doctor Stresses Intuition of Touch, Not Technology

July 29, 2010 at 12:00 AM EDT
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Special correspondent Fred de Sam Lazaro reports on one doctor's mission to promote a hands-on approach to healing and diagnosis. He speaks with doctor and author Abraham Verghese.
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JIM LEHRER: Finally tonight: a doctor’s call to healing.

Special correspondent Fred de Sam Lazaro talks to author and physician Abraham Verghese.

A version of this story aired on PBS’ “Religion and Ethics Newsweekly.”

FRED DE SAM LAZARO: Abraham Verghese has all the credentials and

degrees befitting a professor at Stanford Medical School. But he is best known and acclaimed for his writing — two bestselling memoirs and a new work of fiction that evoke a different kind of medical vocation.

DR. ABRAHAM VERGHESE, author and physician: My desire to be a physician had a lot to do with that sense of medicine as a ministry of healing, not just a science, and not even just a science and an art, but also a calling, also a ministry.

FRED DE SAM LAZARO: His goal is to have today’s medical students aspire similarly to a calling, as much as a career in medicine, to awaken a more basic curiosity as they sharpen their clinical acumen. These third-year medical students were studying abnormalities on a scan, specifically the prominence of certain blood vessels

DR. ABRAHAM VERGHESE: This is what’s called pulmonary redistribution. Have you heard that term? It’s an early sign of heart failure. Who’s got good hand veins that I can borrow?

FRED DE SAM LAZARO: Verghese offered a simple physics explanation of why blood vessels should not normally be visible above the level of the heart.

DR. ABRAHAM VERGHESE: The level of her right atrium is about here. OK? So watch what happens as I raise her hand. You still see the veins, nice three dimension, right? See how they’re flattening out? They are gone.

FRED DE SAM LAZARO: The bottom line: Well before an X-ray, a doctor might spot telltale signs of disease.

DR. ABRAHAM VERGHESE: And you see their neck veins, and they’re not coughing, speaking, singing, straining, they have increased venous pressure.

FRED DE SAM LAZARO: Increasingly, he says students and practitioners of medicine in the West rely on technology, in a system that stresses cognitive knowledge and machines over the skill that comes from touch and feel.

DR. ABRAHAM VERGHESE: I’m the first to admit that the resolution of a hand feeling the belly doesn’t compare with the resolution of a CAT scan scanning the belly, but only my hand can say that it hurts at this spot and not at this spot. Only my hand can say that. Only my hand can say that this pulsatile mass, which might be an aneurysm, is also painful, which is therefore maybe a leaking aneurysm. You know, there are nuances to the exam that no machine is going to give you.

FRED DE SAM LAZARO: It’s a theme Verghese has sounded repeatedly over

the years, writing in magazines, including The New Yorker and Atlantic, and now in a bestseller called “Cutting For Stone.” It fulfills a long-held desire to write fiction, as he told this book club in Menlo Park, California.

DR. ABRAHAM VERGHESE: Dorothy Allison, wonderful American writer, she says, fiction is the great lie that tells the truth about how the world lives.

FRED DE SAM LAZARO: The setting for Verghese’s novel is far from Silicon Valley — a mission hospital in Ethiopia. It is a textured 650-page narrative set amid that country’s turmoil in the ’60s and ’70s. Its stories of medicine, doctors and future doctors at the hospital all illustrate what the author calls the samaritan role of the healer.

Verghese went from med school in India to Boston, Tennessee, Texas, then Stanford. He was born and raised in Ethiopia to parents originally from Kerala, India, and from its Syriac Orthodox traditions. Faith was a big part of life for this and other expatriate communities in the Addis Ababa of his youth, which may unwittingly have shape some of the novel’s characters.

WOMAN: You said that what really inspired you to write the book was that you wanted to write a book that would get people interested perhaps in medicine.

DR. ABRAHAM VERGHESE: Yes.

WOMAN: But there was so much in the book about faith…

DR. ABRAHAM VERGHESE: Yes.

WOMAN: .. and different types of faith. And so how did you come to have so much of this — of another theme in your book?

DR. ABRAHAM VERGHESE: Well, you know, the honest answer is that I don’t really know. It all just sort of evolved that way. And I think, when you’re in medicine, you — you — you agonize over matters of faith.

FRED DE SAM LAZARO: Verghese says most students today enter medical school with the same deep commitment to caring for the sick as the missionaries in his fictional African hospital, but he says that zeal often gets lost in today’s health care system.

DR. ABRAHAM VERGHESE: I joke, but only half-joke, that, if you show up in an American hospital missing a finger, no one will believe you until they get a CAT scan, MRI, and orthopedic consult.

(LAUGHTER)

FRED DE SAM LAZARO: All the emphasis on machines, he says, adds cost to the health care system, and comes at the expense of one of our most important rituals, a visit with one’s doctor.

DR. ABRAHAM VERGHESE: Rituals are about transformation. You know, we marry with great ceremony to signal a transformation. We are baptized in a ritual to signal a transformation.

The ritual of one individual coming to another and confessing to them things they wouldn’t tell their spouse, their preacher, their rabbi, and then even more incredibly, disrobing and allowing touch, which in any other context would be assault, you know, tell me that that’s not a ritual of great significance.

And if we short-change the ritual by not being attentive, or you are inputting into the computer while the patient’s talking to you, you basically are destroying the opportunity for the transformation. And what is a transformation? It’s the sealing of the patient-physician bond.

FRED DE SAM LAZARO: Ironically, Verghese says, research is emerging that corroborates the importance of this bond, the virtue of the samaritan healer.

DR. ABRAHAM VERGHESE: We’re learning that you can have a powerful effect on patients, or a powerful negative effect on patients, based on context, based on your tone of voice. They are actually associated with significant chemical changes in the brain.

The Parkinson’s patients’ dopamine levels go up with a placebo. We’re now able to show that the words of comfort trigger biological reactions which are the very things that you want, and you can use drugs to get there, or you can use words of comfort to get there, which would make your drugs so much more effective. It’s an incredible insight, and, you know, a couple of decades now of practicing medicine, it’s lovely to come full circle to where I started, but with the science to back it up.

FRED DE SAM LAZARO: Verghese has already started on his next work of fiction, the story of an elderly small-town doctor in Texas.