The Human Factors of Medicine
Abraham Verghese, MD, the American Society of Hematology (ASH) Clinical News®
In the wide-ranging interview, Verghese speaks frankly about the danger of losing sight of patients under the deluge of data that is now available to clinicians. In recent years, Verghese’s primarily focused on ways to keep the human element of medicine alive, even as physicians embrace technology and data science. He notes, “Every day, new patients come to see a physician, and if the physician and the patient don't connect on a human level on that first meeting, it affects everything that follows, including compliance and treatment outcomes.”
When his research group at Stanford University decided to focus on the art and science of human connection in medicine, they began their study by conducting an extensive literature survey on that sense of patient-physician connection and how to better foster that relationship. Physicians, patients, and people from nonmedical professions that involve intense interpersonal interactions (like firefighters and social workers) were interviewed to find the most effective practices for fostering physician presence and connection with patients.
Verghese explains, “The patient-physician interaction is one human being coming to another in distress. All the data in the world can't substitute for one's desire to be comforted by another human being.” However, clinicians also need to deliver evidence-based care. Because of the volume of patients, a physician must see, they struggle with cultivating physician presence.
The Stanford study identified five practices to enhance a physician interaction with their patients. They are as follows:
- Preparing for the encounter with intention.
- Listening intently and completely to the patient.
- Agreeing with the patient on what matters most.
- Connecting with the patient's story.
- Exploring emotional cues.
Results from the study were recently published in the Journal of the American Medical Association (JAMA).
In the interview, Verghese recounts how his early experience as an orderly in a nursing home first sparked this interest in the humanity of medicine. It later crystalized with the arrival of the HIV epidemic in the 1980s. He says that prior to that, he was caught up in what he calls the "conceit of cure" – the idea that doctors could fix anything. “If you made an astute diagnosis, you could have a patient rise like Lazarus and walk out of the hospital.” HIV humbled him, because he and his fellow physicians watched young men succumb to a fatal disease for which they had absolutely no treatment. However, the physicians did learn how much their presence and caring mattered to these HIV-stricken men.
Writing became Verghese’s escape and salvation. He chronicled his experience of witnessing the devastation of HIV in a small town in Tennessee, first in a short story published in the New Yorker and then in two books My Own Country: A Doctor's Story and The Tennis Partner. In 2010 his epic novel Cutting for Stone was published bringing him both acclaim and a position at Stanford. His newly released 2023 book is The Covenant of Water.
(Gleaned from an interview in the May 2023 issue of American Society of Hematology (ASH) Clinical News®
To read the entire interview with Abraham Verghese, MD click on