Sometime during medical school, I heard about a book about treating patients during the onset of the AIDS epidemic in America. I was surprised and delighted to learn that the author, Abraham Verghese, was Indian, and, like me, his roots were from Kerala, India. Given my deep interest in HIV medicine and Infectious Diseases at the time, I quickly devoured his non-fictional work My Own Country: A Doctor’s Story. It was a collection of stories about his very personal and touching encounters with AIDS patients (and at that time, all patients with HIV indeed had AIDS as there was no treatment for it yet). He told heartbreaking tales of the patients’ bitter lives and deaths, isolated from society and many times from their own families because of their diagnosis. Even health care professionals were afraid to touch them because many thought HIV could be contracted by touching the patient or even breathing the same air. In a time when these patients had no one else, Dr. Verghese found the compassion and bravery to care for them.
One of the most important aspects of his care was the power of human touch. In his TED Talk, he lifts the physical exam to the status of one of the most innovative advances in modern medicine. Now that we have abundant technologies, therapies, medications, and interventions that continually expand and grow to treat once fatal disorders, we seem to have lost that ever-important reliance on the physical exam and the verbal history taking. Looking back, I was very fortunate in my fairly recent medical training to have been taught to always allow the patient to tell me in their own words what was bothering them, never coaxing them with cues or clues, and also to always examine the patient fully undressed during my first encounter with them. Admittedly, with time constraints and demanding workloads, this has become more and more difficult. I still make it a point to obtain as thorough a history as I can, every time, but examining the patient very thoroughly from head to toe is not always possible or feasible in our quick-paced workplace environment. Dr. Verghese’s talk reminded me that I need to step back, remember why I went into medicine, and remember that the patient in front of me is who I am treating, not the CT scans and EKGs and progress notes that consume most of our time. He reminded me to go back and re-examine my own thoughts on the topic of touch and trust, and to reignite my efforts to incorporate this into every patient encounter.
In addition to being a well-respected physician and teacher of medicine, Dr. Verghese is a wonderfully gifted writer. His fictional work Cutting for Stone is one of my all-time favorite works. He weaves a decades-long story magically and gracefully, incorporating medicine in such a beautiful and human way. I have yet to read his other work, The Tennis Partner, but it is on the list!
If you’d like to watch his TED talk, here it is: