First, a some excerpts from an article about Dr. Verghese, from The New York Times of October 12. It's very definitely worth reading the whole thing.
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"Dr. Verghese (ver-GEESE) is the senior associate chairman for the theory and practice of medicine at Stanford University. He is also the author of two highly acclaimed memoirs, “My Own Country” and “The Tennis Partner,” and a novel, “Cutting for Stone,” which is now a best seller.
"At Stanford, he is on a mission to bring back something he considers a lost art: the physical exam. The old-fashioned touching, looking and listening — the once prized, almost magical skills of the doctor who missed nothing and could swiftly diagnose a peculiar walk, sluggish thyroid or leaky heart valve using just keen eyes, practiced hands and a stethoscope.
"Art and medicine may seem disparate worlds, but Dr. Verghese insists that for him they are one. Doctors and writers are both collectors of stories, and he says his two careers have the same joy and the same prerequisite: “infinite curiosity about other people.” He cannot help secretly diagnosing ailments in strangers, or wondering about the lives his patients lead outside the hospital.
“'People are endlessly mysterious,' he said in an interview in his office at the medical school, where volumes of poetry share the bookshelves with medical texts, family photos and a collection of reflex hammers.
"He is out to save the physical exam because it seems to be wasting away, he says, in an era of CT, ultrasound, M.R.I., countless lab tests and doctor visits that whip by like speed dates. Who has not felt slighted by a stethoscope applied through the shirt, or a millisecond peek into the throat?
"Some doctors would gladly let the exam go, claiming that much of it has been rendered obsolete by technology and that there are better ways to spend their time with patients. Some admit they do the exam almost as a token gesture, only because patients expect it.
"Medical schools in the United States have let the exam slide, Dr. Verghese says, noting that over time he has encountered more and more interns and residents who do not know how to test a patient’s reflexes or palpate a spleen. He likes to joke that a person could show up at the hospital with a finger missing, and doctors would insist on an M.R.I., a CT scan and an orthopedic consult to confirm it.
"Dr. Verghese trained before M.R.I. or CT existed, in Ethiopia and India, where fancy equipment was scarce and good examination skills were a matter of necessity and pride. He still believes a thorough exam can yield vital information and help doctors figure out which tests to order and which to skip — surely a worthwhile goal as the United States struggles to control health care costs, he said.
"A proper exam also earns trust, he said, and serves as a ritual that transforms two strangers into doctor and patient.
"Stanford recruited him in 2007, in large part because of his enthusiasm for teaching the exam. He seized the bully pulpit."
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Yesterday I found myself in my doctor's office here in Xalapa, Veracruz, Mexico. My regular doctor. We sat and talked for awhile: lots of questions from him, lots of careful listening. He noticed two of my complaints before I even mentioned them: a red blotch on the top of my hand and some trembling. Then we went to the physical exam. I remember why human beings, trained and dedicated and compasionate are not machines.Touch, hearing, sight, smell and mind woven together by years of experience, focused on a specific person, following signs down muscles and veins, listening to the woosh and thump of the heart, testing the elasticity of the skin. Checking color and clarity, texture. Noting sadness or fear or listlessness or wistfulness.
Then we talk some more. He asks more questions, then presents some hypotheses and some conclusions. He writes out on crisp thick paper his instructions for me, orders for tests he thinks would be helpful, and prescriptions as necessary. Like a teacher, he presents what he has written, going over the instructions and reasons for them, talking about the prescriptions and the tests he is prescribing. He answers all my questions, sometimes knowing the answers, sometimes saying we will have to wait and see.
The appointment takes about an hour. He schedules most appointments to be an hour. After I leave, I am surprised yet again at the thoroughness of his exams, the care he takes, his skill, and the trust I have in him.
It was much to my surprise to find the kind of care Abraham Verghese advocates for here in Mexico. And contrary to some opinions in the US, a hands-on physician offers a lot more than simply a bridge to trust beteen doctor and patient. It offers the doctor knowledge about his patient that is not only a way to avoid expensive tests, but a way to really be able to monitor her patient's condition and build a profound knowledge of the patient over time.
Where we live, there are very few non-Mexicans. When our family knew we were moving here, they had a lot of concern about the kind of medical care we would receive. My son even advocated that we buy the kind of insurance which would pay for helicopter evacuation in the case of serious medical issues.Though we didn't tell them, at the time, we shared soome of their concerns.
Instead, we found ourselves increasingly inclined to seek medical care here and NOT in the US.
And it is not just because of our personal doctor. I also go to a gynecologist and an ENT here and my husband sees a cardiologist and an opthalmologist with whom we are very satisfied, to say the least. And I endured an episode with a food toxin last Christmas following a meal in a restaurant (the first time I'd gotten sick in a Mexican restaurant in years, and the last time I have). I could not stop vomiting and thought I was dying since I could barely breathe between upchucks. I ended up in the emergency room. As with all facilities heere, there was nothing fancy: no interior decorating, no carpeting. But I got what I needed from very attentive medical staff. Because I was covered by the state health insurance program, I ended up paying the hospital abou $8.00 and about $60.00 for medication.
More impotant than the price is the expertise, the attentiveneness, the warmth of all these medical professionals.Here, nobody appears concerned about not appearing professional if they show themselves to be warm and caring and comfortable using touch.
If Dr. Verghese would like to refresh his faith in physicians, he can come here to our area of Mexico to find some comrades who will support him. At least some doctors here find the US medical system at the moment to be pretty strange.