An infectious disease physician and a writer, Abraham Verghese is Senior Associate Chair, and Professor of the Theory and Practice of Medicine in the Department of Medicine at Stanford University. He was invited as keynote speaker at the annual meeting of the American Association of Equine Practitioners. In this era of the technological and digital powerplay he is warning the (equine) veterinary profession about losing the real physical contact between the veterinarian and the patients under their care. Here is a short summary of his AAEP presentation in San Francisco.
In presenting his vision of humanistic medicine in an era in which the physician’s focus has shifted from the patient to the patient’s data, keynote speaker Dr. Abraham Verghese laments that the “iPatient” is receiving wonderful treatment across America; the real patient, not so much.
According to Dr. Verghese, the consequences of this shift away from hands-on medicine and the “Samaritan function of the profession” are four-fold and mirror some of the challenges faced by equine veterinarians:
1. Patient dissatisfaction: As the data has transcended the individual patient, the doctor-patient relationship is no longer an equal partnership while the diagnostic and trust-building benefits of the physical exam are diminished.
2. Physician, PA and NP wellness: Dr. Verghese said 50% of primary care physicians are burned out, with electronic medical records a major cause. For every one hour spent with a patient, physicians spend two hours working with electronic medical records and one to two hours at home with medical-related emails.
3. Medical errors: With increased use of technology, physicians don’t trust their senses the way they once did. In a paper authored by Dr. Verghese and colleagues and published in the American Journal of Medicine, of 208 medical errors and adverse events vignettes that met inclusion criteria, the oversight was caused by a failure to perform the physical exam in 63%.
4. Loss of ritual: Dr. Verghese cited a portion of the AAEP Touch program as a universal truth among horse and human doctors, specifically that the examination is much more than an examination. “If we think of the examination solely as a clinical tool, we miss the opportunity to create stronger relationships with our clients.”
In closing, Dr. Verghese cited Sir William Osler’s valedictory address at McGill University, which is as relevant today as it was when delivered in 1875: “Patients will form an estimate of you by the way in which you conduct yourself at the bedside. Skill, whether in the simple act of feeling the pulse, will establish more confidence in you than any diploma.”