Finding Joy in Physical Exam Skills

Abraham Verghese, MD, MACP interviewed by Zubin Damania

In an interview with hospitalist, Twitter personality and “Incident Report” host Zubin Damania, Abraham Verghese, MD, MACP, discusses the movement to bring physicians back to the bedside. Their hour-long conversation focuses on the joy that physicians experience from being skilled diagnosticians at the bedside and on the impact of technology, which is sometimes pitted against the doctor-patient relationship or against the physicians’ own diagnostic skills as was the case recently with artificial intelligence.

Verghese encourages something different: pursuit of how it can best serve the human relationship in medicine, because, he says, there will always be a “human being at the end of the experience.” Verghese tells Damania that he supports – and even celebrates – technological advances but also values the experience that comes from the integration of the ritual, scientific and technological aspects of medicine: “There are certain diagnoses that can only be made through a physical exam, and there is joy in discovering how much your eyes can tell you.”

It’s a feeling that medical students, who begin their journey with an eagerness to be at the bedside, crave. But as described by Verghese, the realization that the current state of medicine requires a great deal of computer work can stifle their enthusiasm. To improve the system, he suggests reassessing technology like electronic health records (EHRs), which were designed for billing purposes and are described as “clunky.” Instead, Verghese says he wants a version that makes the information easier to digest and more visually represents the complexities of a patient. He says the ability to see the full trajectory of a patient’s illness could help the physician make a more informed diagnosis or, at the very least, ask a better level of questions.

Not all bedside technology has the same unintended negative consequences as the EHR. Verghese specifically mentions point-of-care ultrasound (POCUS) as an example of how technology can complement the physical exam and bring added diagnostic capabilities to the patient's bedside. Here, says Verghese, the technology sparks engagement and communication, facilitating a stronger connection with the patient.

You can view the full episode of “Incident Report & Against Medical Advice” here.

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