TED Radio Hour
7:11 am
Fri March 15, 2013

Is The Human Hand Our Best Technology?

Originally published on Fri August 16, 2013 8:58 am

Part 4 of the TED Radio Hour episode Do We Need Humans?

About Abraham Verghese's TEDTalk

Modern medicine is in danger of losing a powerful, old-fashioned tool: human touch. Physician and writer Abraham Verghese describes our strange new world where patients are data points, and calls for a return to the traditional physical exam.

About Abraham Verghese

In our era of the patient-as-data-point, Abraham Verghese believes in the old-fashioned physical exam, the bedside chat, the power of informed observation. Before he finished medical school, Abraham Verghese spent a year on the other end of the medical pecking order, as a hospital orderly. Moving unseen through the wards, he saw the patients with new eyes, as human beings rather than collections of illnesses. The experience has informed his work as a doctor — and as a writer. "Imagining the Patient's Experience" was the motto of the Center for Medical Humanities & Ethics, which he founded at the University of Texas San Antonio, where he brought a deep-seated empathy. He's now a professor for the Theory and Practice of Medicine at Stanford, where his old-fashioned weekly rounds have inspired a new initiative, the Stanford 25, teaching 25 fundamental physical exam skills and their diagnostic benefits to interns. He's also the author of a number of books, including his most recent, Cutting For Stone.

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Transcript

GUY RAZ, HOST:

So everything we've been hearing so far is like one long windup to Dr. Abraham Verghese.

DR. ABRAHAM VERGHESE: Yes, speaking.

RAZ: Did I pronounce that correctly?

VERGHESE: Yes, it's Verghese, as in geese.

RAZ: And Abraham Verghese specializes in infectious disease.

VERGHESE: I'm a senior associate chair of the Department of Medicine at Stanford.

RAZ: And he works with the absolute best medical technology in the world, and when he gave his TED Talk, he started with this story.

VERGHESE: I tell the story of this woman who came into a hospital close by, where she came in an extremist.

(SOUNDBITE OF ABRAHAM VERGHESE TED TALK)

VERGHESE: Her blood pressure was an alarming 230 over 170. Within a few minutes she went into cardiac collapse. They quickly resuscitated her and stabilized her. The miracles of modern medicine, and rushed her to the CAT scan suite ... Because they were concerned about blood clots in the lung ... Or some other catastrophic reason for her circulatory collapse ... And the CAT scan revealed ... it was not that she had blood clots ... but it showed visible ... bilateral ... palpable breast masses, breast tumors, that had metastasized ...

All over the body. And the great tragedy is that she had been seen in various health care settings, four or five times, in the preceding two years ...

(SOUNDBITE OF ABRAHAM VERGHESE TED TALK)

VERGHESE: Four or five opportunities to see the breast masses, touch the breast mass, intervene at a much earlier stage than when we saw her. Ladies and gentlemen, that is not an unusual story. Unfortunately, it happens all the time. I joke, but I only half joke that if you come to one of our hospitals missing a limb, no one will believe you till they get a CAT scan, MRI, or orthopedic consult. This may actually be heresy to say this at TED, but I'd like to introduce you to the most important innovation, I think, in medicine to come in the next 10 years, and that is the power of the human hand to touch, to comfort, to diagnose, and to bring about treatment.

RAZ: Hey, robots, are you listening? Dr. Verghese does something you cannot.

VERGHESE: I think, you know, in our sophistication, sometimes we forget that one timeless aspect of our profession has been of that kind of level of reassurance and comfort, which I think will never quite go away. I had an interesting debate with a well heeled and very knowledgeable venture capital sort of person, who, you know, has access to all kinds of information about illness, and really has tried to make the case with me that there will not need to be a physician in a short time. It'll all be accessible to us by computers, and I was thinking as you said that, you just haven't suffered enough. When you suffer enough, what you want especially in addition to your best technology, best chemo, you also want a caring, empathetic physician who really expresses concern for you. And I think that aspect is why I came up with that phrase, that the most important innovation in the next decade will be recognizing the power of the human hand. Not just to diagnose, but to comfort, to reassure, and to say, I will walk this path with you to the end of the line. I'll be with you. That is very important.

RAZ: So when he gave his TED Talk, Abraham Verghese tells a story about another doctor and the human touch. And that doctor's name was Joseph Bell. He was a professor of medicine at the University of Edinburgh.

(SOUNDBITE OF ABRAHAM VERGHESE TED TALK)

VERGHESE: So picture Bell sitting in the outpatient department, students all around him, patients signing up in the emergency room and being registered and being brought in. And a woman comes in with a child, and Conan Doyle describes the following exchange. The woman says, good morning. Bell says, what sort of crossing did you have on the ferry from Burntisland? She says, it was good. And he says, what did you do with the other child? She says, I left him with my sister at Leith. And he says, and did you take the shortcut down Inverleith Row to get here to the infirmary? She says, I did. And he says, would you still be working at the linoleum factory? And she says, I am.

And Bell then goes on to explain to the students, he says, you see, when she said good morning, I picked up her Fife accent and the nearest ferry crossing from Fife is from Burntisland, and so she must've taken the ferry over. He noticed that the coat she's carrying is too small for the child who was with her, and therefore she started out the journey with two children, but dropped one off along the way. You notice the clay on the soles of her feet. Such red clay is not found within a hundred miles of Edinburgh, except in in the botanical gardens, and therefore she took a shortcut down Inverleith Row to arrive here. And finally, she has a dermatitis on the fingers of her right hand, a dermatitis that is unique to the linoleum factory workers in Burntisland. And when Bell actually strips the patient and begins to examine the patient, you can only imagine how much more he would discern.

And as a teacher of medicine, as a student myself, I was so inspired by that story. But you might not realize that our ability to look into the body, in the simple way, using our senses is quite recent. The picture I'm showing you is of Leopold Auenbrugger, who in the late 1700's discovered percussion. And the story is that Leopold Auenbrugger was the son of an innkeeper, and his father used to go down into the basement to tap on the sides of "caffes" (ph) of wine to determine how much wine was left and whether to reorder. And so when Auenbrugger became a physician, he began to do the same thing. He began to tap on the chests of his patients, on their abdomens, and basically everything we know about percussion, which you can think of as an ultrasound of its day - organ enlargement, fluid around the heart, fluid in the lungs, abdominal changes - all of this he described in this wonderful manuscript "Inventum Novum," "New Invention," which would have disappeared into obscurity, except for the fact that this physician, Corvisart - a famous French physician - famous only because he was physician to this gentleman, Corvisart re-popularized and reintroduced the work.

And it was followed a year or two later by Laennec discovering the stethoscope. Laennec, it is said, was walking in the streets of Paris and saw two children playing with a stick. One was scratching at the end of the stick, another child listened at the other end. And Laennec thought this would be a wonderful way to listen to the chest or listen to the abdomen, using what he called "the cylinder," later he had renamed it the stethoscope. And that is how stethoscope and auscultation was born. So within a few years, in the late 1800s, early 1900s, all of a sudden, the barber surgeon had given way to the physician who was trying to make a diagnosis.

And then rapidly after that followed things like the EKG, and angiograms, and then CAT scans and MRI. But only the hand can tell where it's tender, where the patient winces. That's only the sort of thing that a human hand and a discerning observer can make up.

RAZ: Back in the mid-1980s, at the height of the AIDS crisis, Abraham Verghese would make the rounds at the hospital where he worked, and it was like a death chamber. Everyone inside was dead or close to dying.

(SOUNDBITE OF ABRAHAM VERGHESE TED TALK)

VERGHESE: I remember every time I went to a patient's deathbed, whether in the hospital or at home, I remember my sense of failure - the feeling of, I don't know what I have to say, I don't know what I can say, I don't know what I'm supposed to do. And out of that sense of failure, I remember I would always examine the patient. I would pull down the eyelid. I would look at the tongue. I would percuss the chest. I would listen to the heart. I would feel the abdomen. And then the next day, I would come and I would do it again. And I wanted to read you this one closing passage about one patient.

I recall one patient who was at that point no more than a skeleton encased in shrinking skin, unable to speak. When he saw me on what turned out to be his last hours on this earth, his hands moved as if in slow motion. And as I wondered what he was up to, his stick fingers made their way up to his pajama shirt, fumbling with his buttons. I realized that he was wanting to expose his wicker basket chest to me, it was an offering, an invitation. I did not decline. I percussed. I palpated. I listened to the chest. I think he surely must have known by then that it was vital for me, just as it was necessary for him. Neither of us could skip this ritual, which had nothing to do with detecting rattles in the lung, or finding the gallop rhythm of heart failure.

No, this ritual was about the one message that physicians have needed to convey to their patients. Although, God knows of late in our hubris we seem to have drifted away, we seem to have forgotten, as if with the explosion of knowledge, the whole human genome mapped out at our feet - we are lulled into inattention, forgetting that the ritual is cathartic to the physician, necessary for the patient. Forgetting that the ritual has meaning and a singular message to convey to the patient. And the message, which I didn't fully understand then, even as I delivered it and which I understand better now is this - I will always, always, always be there. I will see you through this. I will never abandon you. I will be with you through the end. Thank you very much.

(APPLAUSE)

RAZ: Dr. Abraham Verghese. His full TED Talk is called The Human Touch, and you can find it at TED.NPR.org.

(SOUNDBITE OF MUSIC)

RAZ: So with all that amazing, incredible, wondrous technology being developed, technology that will really change the way we relate to each other, we're still limited. There are things technology will never be able to replicate, like the human soul and the human touch. And there's something reassuring about that. Don't you think?

(SOUNDBITE OF MUSIC)

RAZ: Thanks for listening to the show this week. If you missed any of it, or you want to hear more, or you want to find out more about who was on it, you can visit TED.NPR.org. You can also find many more TED Talks at TED.com. And you can download this program through iTunes or through the NPR smart phone app. Transcript provided by NPR, Copyright NPR.

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