Podcast: Medicine and the Machine
Join Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on?Medicine and the Machine as they discuss the power and pitfalls of artificial intelligence, and how it will change modern medicine. Subscribe now
Abraham Verghese, MD, MACP, is Professor and Linda R. Meier and Joan F. Lane Provostial Professor, and Vice Chair for the Theory and Practice of Medicine at the School of Medicine at Stanford University. He is also a best-selling author and a physician with a reputation for his focus on healing in an era where technology often overwhelms the human side of medicine. He received the Heinz Award in 2014 and was awarded the National Humanities Medal, presented by President Barack Obama, in 2015.
Born in Addis Ababa in 1955, the second of three sons of Indian parents recruited by Emperor Haile Selassie to teach in Ethiopia, he grew up near the capital and began his medical training there. When the emperor was deposed, Verghese briefly joined his parents in the United States, working as an orderly, or nursing assistant, in a series of hospitals and nursing homes before completing his medical education in India at Madras Medical College. His experiences of civil unrest and his time as a hospital orderly were to leave a significant mark on his life and work.
After graduation, he left India for a medical residency in the United States and, like many other foreign medical graduates, he found only the less popular hospitals and communities open to him, an experience he described in a 1997 New Yorker article, “The Cowpath to America.”
From Johnson City, Tennessee, where he was an internal medicine resident from 1980 to 1983, he moved to the Northeast for a fellowship at Boston University School of Medicine, working at Boston City Hospital for two years. It was there that he first saw the early signs of the HIV epidemic. Returning to Johnson City as an assistant professor of medicine, he saw a second epidemic—rural AIDS—and his life took a turn for which he was unprepared. Verghese found himself caring for a surprisingly large number of patients with HIV in a small town where all national projections had suggested he would see none, or perhaps one, a year.
This was an era when little could be done against the virus that caused AIDS other than trying to prevent and treat opportunistic infections; Verghese witnessed and was deeply affected by many premature and tragic deaths. He would write later about being humbled by the experience and recognizing that prior to this he had been caught up in the “conceit of cure.” His work in Tennessee taught him the difference between healing and curing. “One can be healed even when there is no cure, by which I mean a coming to terms with the illness, finding some level of peace and acceptance in such a terrible setting; this is something a physician can, if they are lucky, help facilitate.”
Abraham Verghese’s early years as an orderly, his care of terminal AIDS patients, and the insights he gained from the deep relationships he formed and the suffering he witnessed were transformative. Though he wrote a seminal scientific paper, he felt the sometimes cold and unimaginative language of science could not begin to capture the nature of the experience for patients and families, nor did it convey his own feelings as he witnessed their journeys. These were the cumulative experiences around which his first book, My Own Country: A Doctor’s Story (1994), is centered.
As his interest in writing grew, he took time off from medicine to study at the Iowa Writers Workshop, where he earned an MFA in 1991. Since then, his work has appeared in the New Yorker, Texas Monthly, Atlantic, The New York Times, The New York Times Magazine, Granta, Forbes, and The Wall Street Journal, among others.
After leaving Iowa, Verghese became professor of medicine and chief of the Division of Infectious Diseases at Texas Tech Health Sciences Center in El Paso, Texas, where he lived for the next 11 years. In El Paso, he finished his first book, chosen as one of the Best Books of the Year by TIME and later filmed for Showtime as My Own Country, directed by Mira Nair and starring Naveen Andrews. His second best-selling book, The Tennis Partner: A Story of Friendship and Loss (1997), explored his friend and frequent tennis partner’s losing struggle with addiction. The Tennis Partner was a New York Times Notable Book of the Year.
Emphasis on the Physician-Patient Relationship
Verghese left El Paso in 2002 to serve as founding director of the Center for Medical Humanities and Ethics at the University of Texas Health Science Center at San Antonio. He brought the empathy for patient suffering honed by his previous experiences to his new work in the medical humanities.
To emphasize the importance of interactive patient care, he gave the new Center a guiding mission: “Imagining the Patient’s Experience.” He saw empathy as a way to preserve the innate caring and sensitivity that brings students to medical school, but which the rigors of their training frequently suppress. Verghese also became more focused on bedside medicine, inviting small groups of medical students to accompany him on bedside rounds. Rounds gave him a way to share one-on-one the value he places on the physical examination in diagnosing patients and demonstrating attentiveness to patients and their families, a vital key in the healing process.
His deep interest in bedside medicine and his reputation as a clinician, teacher, and writer led to his recruitment to Stanford University School of Medicine in 2007 as a tenured professor and senior associate chair for the Theory and Practice of Medicine. He has since been named the Linda R. Meier and Joan F. Lane Provostial Professor Vice Chair for the Theory and Practice of Medicine at the Stanford School of Medicine.
In his writing and work, Abraham Verghese continues to emphasize the importance of bedside medicine and physical examination in an era of advanced medical technology. He contends that the patient in the bed often gets less attention than the patient data in the computer. His December 2008 article in the New England Journal of Medicine, “Culture Shock: Patient as Icon, Icon as Patient,” clearly lays out his viewpoint.
Speaking about his novel, Cutting for Stone, he also addressed the issue: “I wanted the reader to see how entering medicine was a passionate quest, a romantic pursuit, a spiritual calling, a privileged yet hazardous undertaking. It’s a view of medicine I don’t think too many young people see in the West because, frankly, in the sterile hallways of modern medical-industrial complexes, where physicians and nurses are hunkered down behind computer monitors, and patients are whisked off here and there for all manner of tests, that side of medicine gets lost.”
Today, as a popular invited speaker, Verghese has more forums beyond his writing in which to share his views on patient care. He speaks widely on the subject, as well as giving talks and readings from his books. At the Stanford School of Medicine, he has led the effort to establish the Stanford 25, where residents and students are taught techniques and skills to recognize the basic phenotypic expressions of disease that manifest as abnormal physical signs.