Abraham Verghese: A doctor’s touch

Abraham Verghese: A doctor’s touch

A few months ago, a 40 year-old woman came to an emergency room in a hospital close to where I live, and she was brought in confused. Her blood pressure was an alarming 230 over 170. Within a few minutes, she went into cardiac collapse. She was resuscitated, stabilized, whisked over to a CAT scan suite right next to the emergency room, because they were concerned about blood clots in the lung. And the CAT scan revealed no blood clots in the lung, but it showed bilateral, visible, palpable breast masses, breast tumors, that had metastasized widely all over the body. And the real tragedy was, if you look through her records, she had been seen in four or five other health care institutions in the preceding two years. Four or five opportunities to see the breast masses, touch the breast mass, intervene at a much earlier stage than when we saw her. Ladies and gentlemen, that is not an unusual story. Unfortunately, it happens all the time. I joke, but I only half joke, that if you come to one of our hospitals missing a limb, no one will believe you till they get a CAT scan, MRI or orthopedic consult. I am not a Luddite. I teach at Stanford. I’m a physician practicing with cutting-edge technology. But I’d like to make the case to you in the next 17 minutes that when we shortcut the physical exam, when we lean towards ordering tests instead of talking to and examining the patient, we not only overlook simple diagnoses that can be diagnosed at a treatable, early stage, but we’re losing much more than that. We’re losing a ritual. We’re losing a ritual that I believe is transformative, transcendent, and is at the heart of the patient-physician relationship. This may actually be heresy to say this at TED, but I’d like to introduce you to the most important innovation, I think, in medicine to come in the next 10 years, and that is the power of the human hand — to touch, to comfort, to diagnose and to bring about treatment. I’d like to introduce you first to this person whose image you may or may not recognize. This is Sir Arthur Conan Doyle. Since we’re in Edinburgh, I’m a big fan of Conan Doyle. You might not know that Conan Doyle went to medical school here in Edinburgh, and his character, Sherlock Holmes, was inspired by Sir Joseph Bell. Joseph Bell was an extraordinary teacher by all accounts. And Conan Doyle, writing about Bell, described the following exchange between Bell and his students. So picture Bell sitting in the outpatient department, students all around him, patients signing up in the emergency room and being registered and being brought in. And a woman comes in with a child, and Conan Doyle describes the following exchange. The woman says, “Good Morning.” Bell says, “What sort of crossing did you have on the ferry from Burntisland?” She says, “It was good.” And he says, “What did you do with the other child?” She says, “I left him with my sister at Leith.” And he says, “And did you take the shortcut down Inverleith Row to get here to the infirmary?” She says, “I did.” And he says, “Would you still be working at the linoleum factory?” And she says, “I am.” And Bell then goes on to explain to the students. He says, “You see, when she said, ‘Good morning,’ I picked up her Fife accent. And the nearest ferry crossing from Fife is from Burntisland. And so she must have taken the ferry over. You notice that the coat she’s carrying is too small for the child who is with her, and therefore, she started out the journey with two children, but dropped one off along the way. You notice the clay on the soles of her feet. Such red clay is not found within a hundred miles of Edinburgh, except in the botanical gardens. And therefore, she took a short cut down Inverleith Row to arrive here. And finally, she has a dermatitis on the fingers of her right hand, a dermatitis that is unique to the linoleum factory workers in Burntisland.” And when Bell actually strips the patient, begins to examine the patient, you can only imagine how much more he would discern. And as a teacher of medicine, as a student myself, I was so inspired by that story. But you might not realize that our ability to look into the body in this simple way, using our senses, is quite recent. The picture I’m showing you is of Leopold Auenbrugger who, in the late 1700s, discovered percussion. And the story is that Leopold Auenbrugger was the son of an innkeeper. And his father used to go down into the basement to tap on the sides of casks of wine to determine how much wine was left and whether to reorder. And so when Auenbrugger became a physician, he began to do the same thing. He began to tap on the chests of his patients, on their abdomens. And basically everything we know about percussion, which you can think of as an ultrasound of its day — organ enlargement, fluid around the heart, fluid in the lungs, abdominal changes — all of this he described in this wonderful manuscript “Inventum Novum,” “New Invention,” which would have disappeared into obscurity, except for the fact that this physician, Corvisart, a famous French physician — famous only because he was physician to this gentleman — Corvisart repopularized and reintroduced the work. And it was followed a year or two later by Laennec discovering the stethoscope. Laennec, it is said, was walking in the streets of Paris and saw two children playing with a stick. One was scratching at the end of the stick, another child listened at the other end. And Laennec thought this would be a wonderful way to listen to the chest or listen to the abdomen using what he called “the cylinder.” Later he renamed it the stethoscope. And that is how stethoscope and auscultation was born. So within a few years, in the late 1800s, early 1900s, all of a sudden, the barber surgeon had given way to the physician who was trying to make a diagnosis. If you’ll recall, prior to that time, no matter what ailed you, you went to see the barber surgeon who wound up cupping you, bleeding you, purging you. And, oh yes, if you wanted, he would give you a haircut — short on the sides, long in the back — and pull your tooth while he was at it. He made no attempt at diagnosis. In fact, some of you might well know that the barber pole, the red and white stripes, represents the blood bandages of the barber surgeon, and the receptacles on either end represent the pots in which the blood was collected. But the arrival of auscultation and percussion represented a sea change, a moment when physicians were beginning to look inside the body. And this particular painting, I think, represents the pinnacle, the peak, of that clinical era. This is a very famous painting: “The Doctor” by Luke Fildes. Luke Fildes was commissioned to paint this by Tate, who then established the Tate Gallery. And Tate asked Fildes to paint a painting of social importance. And it’s interesting that Fildes picked this topic. Fildes’ oldest son, Philip, died at the age of nine on Christmas Eve after a brief illness. And Fildes was so taken by the physician who held vigil at the bedside for two, three nights, that he decided that he would try and depict the physician in our time — almost a tribute to this physician. And hence the painting “The Doctor,” a very famous painting. It’s been on calendars, postage stamps in many different countries. I’ve often wondered, what would Fildes have done had he been asked to paint this painting in the modern era, in the year 2011? Would he have substituted a computer screen for where he had the patient? I’ve gotten into some trouble in Silicon Valley for saying that the patient in the bed has almost become an icon for the real patient who’s in the computer. I’ve actually coined a term for that entity in the computer. I call it the iPatient. The iPatient is getting wonderful care all across America. The real patient often wonders, where is everyone? When are they going to come by and explain things to me? Who’s in charge? There’s a real disjunction between the patient’s perception and our own perceptions as physicians of the best medical care. I want to show you a picture of what rounds looked like when I was in training. The focus was around the patient. We went from bed to bed. The attending physician was in charge. Too often these days, rounds look very much like this, where the discussion is taking place in a room far away from the patient. The discussion is all about images on the computer, data. And the one critical piece missing is that of the patient. Now I’ve been influenced in this thinking by two anecdotes that I want to share with you. One had to do with a friend of mine who had a breast cancer, had a small breast cancer detected — had her lumpectomy in the town in which I lived. This is when I was in Texas. And she then spent a lot of time researching to find the best cancer center in the world to get her subsequent care. And she found the place and decided to go there, went there. Which is why I was surprised a few months later to see her back in our own town, getting her subsequent care with her private oncologist. And I pressed her, and I asked her, “Why did you come back and get your care here?” And she was reluctant to tell me. She said, “The cancer center was wonderful. It had a beautiful facility, giant atrium, valet parking, a piano that played itself, a concierge that took you around from here to there. But,” she said, “but they did not touch my breasts.” Now you and I could argue that they probably did not need to touch her breasts. They had her scanned inside out. They understood her breast cancer at the molecular level; they had no need to touch her breasts. But to her, it mattered deeply. It was enough for her to make the decision to get her subsequent care with her private oncologist who, every time she went, examined both breasts including the axillary tail, examined her axilla carefully, examined her cervical region, her inguinal region, did a thorough exam. And to her, that spoke of a kind of attentiveness that she needed. I was very influenced by that anecdote. I was also influenced by another experience that I had, again, when I was in Texas, before I moved to Stanford. I had a reputation as being interested in patients with chronic fatigue. This is not a reputation you would wish on your worst enemy. I say that because these are difficult patients. They have often been rejected by their families, have had bad experiences with medical care and they come to you fully prepared for you to join the long list of people who’s about to disappoint them. And I learned very early on with my first patient that I could not do justice to this very complicated patient with all the records they were bringing in a new patient visit of 45 minutes. There was just no way. And if I tried, I’d disappoint them. And so I hit on this method where I invited the patient to tell me the story for their entire first visit, and I tried not to interrupt them. We know the average American physician interrupts their patient in 14 seconds. And if I ever get to heaven, it will be because I held my piece for 45 minutes and did not interrupt my patient. I then scheduled the physical exam for two weeks hence, and when the patient came for the physical, I was able to do a thorough physical, because I had nothing else to do. I like to think that I do a thorough physical exam, but because the whole visit was now about the physical, I could do an extraordinarily thorough exam. And I remember my very first patient in that series continued to tell me more history during what was meant to be the physical exam visit. And I began my ritual. I always begin with the pulse, then I examine the hands, then I look at the nail beds, then I slide my hand up to the epitrochlear node, and I was into my ritual. And when my ritual began, this very voluble patient began to quiet down. And I remember having a very eerie sense that the patient and I had slipped back into a primitive ritual in which I had a role and the patient had a role. And when I was done, the patient said to me with some awe, “I have never been examined like this before.” Now if that were true, it’s a true condemnation of our health care system, because they had been seen in other places. I then proceeded to tell the patient, once the patient was dressed, the standard things that the person must have heard in other institutions, which is, “This is not in your head. This is real. The good news, it’s not cancer, it’s not tuberculosis, it’s not coccidioidomycosis or some obscure fungal infection. The bad news is we don’t know exactly what’s causing this, but here’s what you should do, here’s what we should do.” And I would lay out all the standard treatment options that the patient had heard elsewhere. And I always felt that if my patient gave up the quest for the magic doctor, the magic treatment and began with me on a course towards wellness, it was because I had earned the right to tell them these things by virtue of the examination. Something of importance had transpired in the exchange. I took this to my colleagues at Stanford in anthropology and told them the same story. And they immediately said to me, “Well you are describing a classic ritual.” And they helped me understand that rituals are all about transformation. We marry, for example, with great pomp and ceremony and expense to signal our departure from a life of solitude and misery and loneliness to one of eternal bliss. I’m not sure why you’re laughing. That was the original intent, was it not? We signal transitions of power with rituals. We signal the passage of a life with rituals. Rituals are terribly important. They’re all about transformation. Well I would submit to you that the ritual of one individual coming to another and telling them things that they would not tell their preacher or rabbi, and then, incredibly on top of that, disrobing and allowing touch — I would submit to you that that is a ritual of exceeding importance. And if you shortchange that ritual by not undressing the patient, by listening with your stethoscope on top of the nightgown, by not doing a complete exam, you have bypassed on the opportunity to seal the patient-physician relationship. I am a writer, and I want to close by reading you a short passage that I wrote that has to do very much with this scene. I’m an infectious disease physician, and in the early days of HIV, before we had our medications, I presided over so many scenes like this. I remember, every time I went to a patient’s deathbed, whether in the hospital or at home, I remember my sense of failure — the feeling of I don’t know what I have to say; I don’t know what I can say; I don’t know what I’m supposed to do. And out of that sense of failure, I remember, I would always examine the patient. I would pull down the eyelids. I would look at the tongue. I would percuss the chest. I would listen to the heart. I would feel the abdomen. I remember so many patients, their names still vivid on my tongue, their faces still so clear. I remember so many huge, hollowed out, haunted eyes staring up at me as I performed this ritual. And then the next day, I would come, and I would do it again. And I wanted to read you this one closing passage about one patient. “I recall one patient who was at that point no more than a skeleton encased in shrinking skin, unable to speak, his mouth crusted with candida that was resistant to the usual medications. When he saw me on what turned out to be his last hours on this earth, his hands moved as if in slow motion. And as I wondered what he was up to, his stick fingers made their way up to his pajama shirt, fumbling with his buttons. I realized that he was wanting to expose his wicker-basket chest to me. It was an offering, an invitation. I did not decline. I percussed. I palpated. I listened to the chest. I think he surely must have known by then that it was vital for me just as it was necessary for him. Neither of us could skip this ritual, which had nothing to do with detecting rales in the lung, or finding the gallop rhythm of heart failure. No, this ritual was about the one message that physicians have needed to convey to their patients. Although, God knows, of late, in our hubris, we seem to have drifted away. We seem to have forgotten — as though, with the explosion of knowledge, the whole human genome mapped out at our feet, we are lulled into inattention, forgetting that the ritual is cathartic to the physician, necessary for the patient — forgetting that the ritual has meaning and a singular message to convey to the patient. And the message, which I didn’t fully understand then, even as I delivered it, and which I understand better now is this: I will always, always, always be there. I will see you through this. I will never abandon you. I will be with you through the end.” Thank you very much. (Applause)

100 thoughts on “Abraham Verghese: A doctor’s touch

  1. I have just qualified as a nurse.

    In England hospital consultants are abrupt, snappy, and patients are an irritation between spending time with their mates on the golf course and their lucrative medicolegal work.

    My father lay dying in hospital. The doctor came in already angry, she bodged around roughly, couldn't find a vein then spoke rudely to my elderly mum and me.

    We wept together over my poor father's bed. How could she be so cruel. I will never forget her.

  2. great speech,
    my friend's doctor didn't even tell her how to use the feeding tube he just put in. For 3 weeks, she didn't know she suppose to clean it and use it. She lost 30 lb by eating liquid food. Not until her first chemo consultation, that doctor send nurse to her house that day to show her how to use the feeding tube.
    Doctors today are over book. While we wait hrs, only able to talk to them for 10 to 15 minutes.

  3. What crap, he places human intuition as if it's some panacea for what ails us and relates a story about a Doctor knowing the history of a woman that is simply impossible in today's modern age. He needs to realize that in a world of 7 billion people it is simply impossible to go back to those old days (which is more nostalgia than truth) and that this call to return to them is infeasible if we want to tend to the sick today.

  4. @FTLNewsFeed
    You might be partially right, but you're also partially wrong.
    It isn't merely in the sake of nostalgia, the basics of history taking, inspection and manual investigations cover a whole lot than you think.
    No doubt final diagnoses need to be confirmed by accurate laboratory and instrumental investigations, but do not undermine the importance and power of a doctor's touch.

    Now, doctors are way too "busy" to give their previous time to those who need it the most – Patients

  5. first he says that the a doctor's touch (physical exam) is a powerful tool in making diagnoses and to "touch, comfort, diagnose, and bring about treatment". however his closing anecdote actually neglects the clinical importance of the exam ("nothing to do with detecting rails in the lungs or finding the gallop of heart failure") and emphasizes only the emotional/ethical aspect of it

  6. @FTLNewsFeed being a medical student myself, I can see that doctors nowadays care less about the patients. history taking and physical examinations is one important aspect to build rapport with the patient. you dont need a series of sophisticated test to find out what is happening, most of the time we just need to ask and discover and interpret from what we find, with our own senses.

  7. I've always been quite healthy and I probably go to a medical doctor about once every ten years – I hope next time I get someone like this.

  8. @lovelittlecats I am sorry about that, i know how the hospital staff can be i lost my mum and they were obnoxious i hope you let her know how she made you feel and maybe put out a complain or write about her on a blog. Such people need to know their job isn't a free power card for them to act however they want to.

  9. @Threeejw I'm not sure if you're trying to be offensive or what. If i said "white doctors are the best", it would be seen as a racist thing to say, no?

  10. @ronnyweasle It's both.

    And likely the closing anecdote is an example of how the patient's innate knowledge of how powerful the doctor's touch is, enables some placebo powers from the ritual itself.

  11. I think if a doctor asked me to strip, i'd feel that there was some kindof weird power interplay going on here.

    I'm not trusting enough of my doctors for the "get naked coz i'm the doctor" kindof ritual, and honestly i don't think i should be. Maybe i just think my doctors arn't very impressive. *shrug*

  12. In my medical school in Croatia rounds still look like the ones from dr. Verghese's student days. I always thought that to be a harsh practice for the pacients, listening about his disease and all possible diagnosees and prognosees. But now I see that is not the case. Thank you dr. Verghese, you opened up my views.

  13. An addendum to the message, from the patient to the physician, is to please learn from this, find something new, and make the future better for someone else whom might not otherwise benefit for the lack of that knowledge. And I don't mean just the physical diagnosis and treatment.

  14. we strive to be humans in an age where we are surrounded by machines – extending our human touch to a fellow human in sickness and in pain…

  15. Have been watching TED lectures for several years now and this is THE BEST I have seen. He makes the points, backs them with evidenciary material and nails every turn. This is not emotion,… it is logic applied to what is a deeply emotional issue… medical care… something between a doctor and a patient. Not being political… just a warning to DOCS… ya wanna be treated that way… then TREAT that way.

  16. 4th year medical student here: despite the new rules and regulations, this video reminds me to never lose sight of true medicine.

  17. AWESOME ! I hope there are people in the health care professions that see this video and think of ways to incorporate at least some of it , in their roles as caretakers of patients.

  18. I'm a medical student and all of this sounds really nice and ideal, but at least in Sweden where I'll most likely end up working there's typically no time for this.I hope it changes, it's quite frankly one of the main reasons that make me question my ambition to become a general practician.

  19. Any physical therapists out there? I am not a PT, but it seems to me that a major strength of PT practice is the amount of time spent with patients, time to perform thorough exams. A spine surgeon might recommend a fusion without even testing muscle strength or reflexes. Hoping to hear some insights from another doctoring profession – PT…

  20. A patient doesn't go directly to an orthopedic specialist before seeing a plethora of physicians in the primary care fields first.
    Physical therapists are geared towards gradually improving a patient's quality of life using exercises, range of motion stretching, etc. It is the nature of their work that enables them to develop such a relationship with the patient. If surgeons were allowed that luxury, it would take even longer to schedule a consult with a specialist

  21. In one sense, this speech is very inspiring. In another, you can tell that the rhetoric used is very catered toward those whom appreciate physical touch. To have his entire Modus Operandi consist of including very interpersonal physical touch – regardless of the nature of the visit – without the least caveat to when (almost described as intimate) physical touch is not warranted, is to use rhetoric to its highest degree.

  22. This is brilliant. Question though – I had the impression earlier that patients in general don't like being touched by the doctor, and would prefer the physical examination to be as truncated as possible, because the body is their personal space and they would prefer to maintain such space?

    And while I'm at it…I would have thought that the average patient would much prefer if her breasts were left alone (referring to the Cancer Centre part of the speech).

  23. awesome ! impressed to find someone emphasising on clinical examination when the whole world is mad after modern gadgets,

  24. Amazing video.. .. I am a doctor from India and I must say that clinical medicine with an intense emphasis on diagnosis and touching the patient still exists in my part of the world ( thankfully) especially in the low funded government hospitals which overflow with multitudes of patient and yet effectively mananged by skilled physicians. However it will not be long before money pours in , the MRIs make their way in and we go the american way. Treat the patient and not just the disease.

  25. Rounds has become hard because of HIPAA laws. Patients share rooms and it has impossible to speak in non private rooms. Sad but true.

  26. I´ve been a doctor for 10 years in Argentina, and I grew up as a professional inspired by great teachers and their "old school" methods… this video provides no "original" information to me (great argentinian phisician and writer Dr. Maglio always says "touch the patients!")… nonetheless is an excellent guide to youg phisicians and med students, because everything Dr. Verghese says is sadly true… as an atending phisician and med school professor I support his ideas completely. I´ll make sure my students watch this. Thank you Dr. Verghese!

  27. WOW this doctor is totally right on. Before I was diagnosed with stage 4 cancer last year, I spent the 2 years prior to my diagnosis, going to at least 8 health care providers in an attempt to find out why I was having increasing and eventually crippling fatigue. Nobody got my diagnosis correct, and when I was diagnosed, it was by accident when I was getting a CT scan of my lungs. During the scan, it clipped my liver which showed 16 metastatic liver tumors.
    Each time I would go for a medical visit, I felt like they weren't truly listening to what I was saying, and often entered the room with a diagnosis already in their head. I was rarely touched. Nobody could enter the room with a clear mind, to find out my true story that was unique to me.
    I think the biggest lesson I learned from this personal experience and working as a RN for 30 years, the pace of office visits need to be slowed down, patients should be touched a lot more, and providers truly need to listen to their patients.

  28. I completely agree with Abraham. With the advances in technology over the years, it seems that that there has been a loss in the patient/physician relationship. More often than not, patients are briefly speaking to doctors that are staring at a computer screen. Patients need the type of doctor that will not rely purely on the machines (such as MRIs and CT scans) to do their work, they will also use the tool of touch and communication to diagnose patients.

    If I were a patient I would want a doctor that makes me feel comfortable, well-informed, and taken care of. One of the quotes from this video that will stick with me is, "I will never abandon you. I will see you through the end." This perfectly describes the type of doctor every patient should be dealing with, someone that will always be looking out for their best interest and that will do everything they can to help them. In order to do this, we do not have to take technology out of practices/hospitals but we do need to begin treating patients as we would want to be treated. The Occupational Therapy field exemplifies this well. An occupational therapist can help a patient recover by getting to know them, using "hands-on" practices, and gearing each therapy session toward the specifics patients needs and interests. This helps a patient engage and feel optimistic about their health condition. I have seen this type of work first hand when my brother was in a car accident. He was paralyzed from the neck down and the doctors told my parents that he would never walk again. By hearing this my brother was discouraged but when the therapists came to help him, they told him they believed in him, they began bringing in his favorite things to aid him in therapy sessions (such as a guitar to try and re-learn how to use his hands again). The positive communication and hands on therapy gave my brother the strength and courage to move forwards. He is now walking today, despite what the doctors said. I firmly believe in the power of touch and communication and how it positively affects the health of patients.

  29. Some very good bits but sadly GPs now have (NHS in the UK) only 7 minutes (I think) per patient and no: a new patent never gets 45 minutes!

    Round (ward round in the UK) WITH the patient = of course. But in 2005 I had a whole gaggle of them (including students, nobody asked if OK with me) herding round my bed and cross because I was in the bathroom when they arrived = as though I was psychic or could see through walls or something. I had never had a ward round before (odd that, several ops) nor ever met the responsible consultant while in hospital after the op. And no, no anaesthetist ever checked up on me after either.

    This ward round replays constantly for me still, a decade later: nobody introduced themselves, they talked about me as though I wasn't there. At the end I had to summon the courage to ask a very important question: why did I wake up in the operating theatre gasping for breath? Nobody replied, the boss (consultant) wouldn't even look at me, the students shuffled their feet in this mega silence, nobody spoke.

    I then glared at the doctor who'd jabbed my abdomen and hurt me pre-op a, he finally said 'it did not happen in theatre' but I knew it had, he lied to me. Nobody wished to hear me, nobody responded as they should have/ KNEW they should/were (I hope!) TRAINED to respond, why? After this lie the consultant told me to go home and they all toddled off. I was in shock.

    And after my bungled op I went to see my GP repeatedly. Not once did he examine me, a VERY quick listen to my heart once after I told him I thought I was going to die the night before because such TERRIBLE chest pain, thought I was having a heart attack. He felt sweating but wrote there was none.

    And I told him about my jerky walking since op and explained how my left big toe joint really hurt. He bent down to peer at it but did not examine it or me EVER. What would make a GP behave like this I wonder?

    Anything to do with the phone call from the hospital (after a sham meeting because I was asking for info about what had gone wrong) the content of which he (twice) refused to tell me? The second time I asked he became angry and snarled 'we can't go into this/that again' = he silenced me. Why did he behave like that when he'd been my GP (and my son's) for so long?

    All their lies, tones of voice, anger, denials, letters, phone calls with them etc. being DUMPED again and again replay. Their lies became 'fact' and my truth/knowledge denied as 'mental health issues/PTSD'. How often do doctors, anaesthetists, GPs, hospitals, counsellors etc. DO that? And how many patients DO commit suicide because our reality (and the truth) are denied as fiction or the product of a troubled mind, delusions? I went out to but couldn't do it: I'm a mum.

    And after time and again hearing me telling my symptoms he (and psychiatric nurse) pressurised me to take antidepressants as a 'cure' for my injuries, the physical ones caused during the op and the psychological ones caused (on purpose, they conspired between themselves, recklessly) by their behaviour ever after. How deluded were THEY?! And why and how were they allowed to get away with it?

    I'd be in prison if I behaved like that to a dog let alone towards a PERSON. Why different rules for them? I can't understand this topsy turvy world.

  30. #Все имеет строгие параметры,как приёма,так и регуляции синтеза расщепления силы из пространства клеткой!.Воспроизведение работы равновесия-есть неукоснительное следствие квант/математ.волнового поглащения изменения/кровь,лимфа,костный мозг,каждый орган/определяется в системе равновесия,как система состоятельности уровню расщепления,через систему передачи памяти кодового уровня!!!.Медицина-есть определение поддержания соответствия минимального уровня понимания процессов Человека,как системы связи,с передачей полноты законов из пространства,что и определяет понятие здоровья,как полноценную систему общности одного целого!!!.В противном случае это не медицина!!!.Все зашло в ту степень,где ваше здоровье не может зависить от генов ваших родителей,в том смысле,что процессы разрушения вышли на отсчет захвата неисполнения процессов мозга идентичности,в следствия цепной реакции продуцирования изменения всей системы связи передачи поддержания…#zZz#.

  31. As a physician of 33 years I have lived through some of the transition that Dr. Verghese describes. His final example was an interaction with an AIDS patient in which the patient physician relationship was of primary importance and value.

    With the scourge of opioid addiction which we are currently experiencing, that same patient centered approach will serve us well as we come to the side of our patients while we work to re-define the generators of their pain, explore alternatives and adjuncts to treatment and down-titrate their opioids to improve our patient's safety. We may provide comfort as we convey that we understand them and will be with them through their journey toward wellness.

  32. So aweasome , ill support this verghese doctor , the clue is" touch and feel"… and what does "TED" mean?

  33. I'm a PA working in South Sudan where we can't rely on electronic gadgets to diagnose a patient's disease. I'm fortunate to have been gotten a good education at Hahnemann University where we learned to narrow down a diagnosis by doing a thorough physical exam and taking a good history. I would not want to work in a hospital in the US today as it seems so impersonal on so many levels. All to CYA in case the patient wants to sue. However, we all have learned that a good medical care combined with good bedside manner and showing true care and concern for your patient will be the best way to protect yourself from being sued.

  34. This man's comforting voice, intellect, and writing/speaking prowess are incredible. We'd all be lucky to have a doctor like this.

  35. Abraham Verghese brings to focus an idea that is very concerning to many people who are patients of any type. To some doctors, they see their patients as a number in the system, a good or bad outcome. Like sated in his speech, talks about how interns are trained, around a computer. The focus not around patient care, but now about what the computer says. When looking at this topic from an ethical standpoint, what are the arutaes of a good doctor? One that is kind and caring, well knowledgeable of medicine, and talks to the patient in a way that they can understand. Based upon this speech and other observations through personal experience, that idea has shifted very minimally today, but what about years down the road. Are the bed side manners of doctors changing from looking at the patient to just looking at the screen? Further, another point Verghese makes is that as a patient and as a doctor, we both have a role. He goes on to say that at the beginning of being a doctor there was a ritual, would go step by step of what a basic physical should be like. Later states that the patient has never been examined quite like this before. Again, going back to a doctor's duty, what is their virtue ethics? Virtue ethics, going after the ultimate good, what should be done first hand for anyone in the healthcare field. We don’t expect our doctor’s to get lazy and skip the simple things within a check up. One simple thing missed early on, for example an unusual feeling on the patient’s neck could be cancerous and furthermore missed because of the doctor's need to go from patient to patient. The last thing is that I also believe that doctors are simply losing the personal relationship with their patients. Just simple conversation lacks and is something that I expect to come from my physician when going in for a checkup or visit. It is that simple conversation that distracts the mind of all the possibilities of the horrible things that can come out of the visit. Also, the conversation makes the patient more willing to talk about what is going on in their life further more allowing the physician to make a better conclusion about what is going on with their patient.

  36. Kept snapping my fingers throughout this presentation like its spoken word. So powerful and profound. Watching in prep for a medical ethics final exam tomorrow based on this clip

  37. It's sad that a talk with a message as plain and simple as this seems somehow 'amazing' or 'inspiring'. I think it's a reflection of the US system. There are numerous comments on this video from doctors in other countries who have always followed this approach. Personally speaking, I've trained and worked as a doctor in the UK NHS for 18yrs. We've had it drilled in to us from day one: The importance of a detailed history and relevant/targeted clinical examination cannot be underestimated.

    The advances in diagnostic testing and imaging techniques however provide us with clinical and pathological information previously impossible to ascertain by clinical examination alone. The art is in understanding how to use them to best serve our patients. I don't put every patient I see through an MRI scanner instead of examining them clinically – I scan only those patients for whom my history and clinical examination has suggested a possible pathology that can be confirmed/excluded by the scan. These advances should been seen as what they really are: another tool to help the physician. Not a replacement for their clinical acumen.

    Rant over. Sorry!

  38. It is enlightening to see such a passionate insight on a physician-patient relationship; something that is not popular to talk about. Great video! Inspiring.

  39. Its horseshit how much power doctors have, they can pretty much decide wether you live or die, especially if your an organ donor, they take your organs kill you off and use ur organs to make them money

    No one person should have power over another. Period. This world has lots of problems, all thats left is to fix the medical feild. If a person needs medical help it should be covered by the state and the money to cover it should be from seized wages, no more private insurance. Every life is important

  40. please go to Mexico to practice medicine and you will see how is to work, without material, without technology, without the basic resources, is only you as a physician and the patients, the challenge is to diagnose him with whatever you have, your brain and stethoscope.

  41. This what I always feel and encounter as a doctor, all of these advances in diagnostic imaging and laboratory tests has striped us from the very one important thing in our job, which is the bonding and communication with our patients

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