Abraham Verghese, M.D.

Artificial intelligence (AI) holds the promise of liberating providers from their clerical and documentation burdens; it might also ease the epidemic of provider burnout and allow for more meaningful patient interactions. Historically, technological advances implemented without sufficient forethought, oversight, and user input, have caused unintended human consequences. A century ago, Peabody famously said "the secret of the care of the patient is in caring for the patient." Healthcare systems need fiscal soundness and inspired leadership; the delivery of care needs people, presence and empathy. The upcoming AI revolution must be matched by a revolutionary rethinking of humanistic healthcare.

The advent of artificial intelligence has revolutionized bank lending, bail decisions, shopping and many other aspects of society and it will revolutionize the diagnosis and treatment of disease, as well as reshape patient interactions with the healthcare system. The decade long experience with the implementation of electronic medical record systems (EMR) has provided some potent lessons: when new technology is widely implemented in a heavy-handed fashion and without consideration for the principal users, there is a human capital cost of burnout, attrition, poor morale and patient dissatisfaction. The EMR experience makes it important to set in place sound use and practice parameters for AI applications, to rate them on an “HI” (Human Intelligence) index that looks at the effect on users and on important work and life rituals. Whether AI is used in diagnosis, or in complex analyses of data, at the end of the day, the result is at best a recommendation that still requires a human to judge its appropriateness and then to implement it or not. Fears about “deskilling” and loss of jobs in medicine are exaggerated; indeed, AI could relieve us of drudgery and allow more time for meaningful interaction with patients and colleagues. For the moment, it will still take HI to apply AI soundly. The ability to generate new thoughts, to make creative associations and think of new avenues of exploration is thus far a unique attribute of the human brain.

All of us, especially those working in healthcare, are living through the story of our lives. Just prior to the COVID vaccine being administered, approximately 1000 people working in healthcare at every level had perished in America. As with the general population, people of color experienced excessive mortality. For each of us the story has played out at many levels: it is the story of our cells, our individual immune systems and vulnerabilities; it is the story of our families, our livelihood; the story has involved our towns, our cities, and our country, and it has played out on a backdrop of wildfires, floods, climate change and the great societal awakening to longstanding issues of racial equity. The story of Covid echoes the classic “monster” stories throughout history. It is instructive to consider the archetypal structure of such stories, especially the endings: we rarely ever return to things the way they were. Instead, we arrive at a new order, a new way of being. In this talk, Dr. Verghese explores the nature of courage, resilience and heroism. COVID has made heroes of all of us as we live through this extraordinary time. We are called to adventure whether we like to or not, forced to find armor, to find allies and special weapons, and to dig deep to find new resources within ourselves.

Every patient comes with a story. In fact, every physician begins by taking a history and that word has the root "story" within it. Even in a technological era, narrative remains important particularly to the patient. Understanding the narrative is critical to patient satisfaction. In this presentation, Abraham relates Aristotelian story structure to medicine; connects elements of story — epiphany and metaphor — to medicine; and reflects on the nature of epiphanies in medicine. He draws on his love of literature, on his experience at the Iowa writers workshop where he obtained a master's degree, and on his lessons learned while writing four bestsellers: two nonfiction books (My Own Country, The Tennis Partner) and two novels—Cutting for Stone, which remained on the bestseller list for over 100 weeks, and his latest release, The Covenant of Water, which debuted on the New York Times bestseller list.

Medicine and medical institutions are increasingly challenged with the problem of physician burnout and attrition. In just the three years between 2011 and 2014, physician burnout increased from 45% to 54%, according to one national survey. Physicians who score high on a burnout index have a 25% risk of leaving their institution in the two years that follow; few institutions can afford that kind of loss after a great investment cost. Dr. Abraham Verghese has pioneered the cause of physician wellness before the term existed. His book, “The Tennis Partner” looked at the causes and symptoms of physician dysphoria through the lens of a personal memoir and the loss of a colleague from suicide. In his academic work, he is at the forefront of those challenging the electronic medical record (EMR) in its present form and pointing out its pernicious effects on the patient-physician relationship and physician wellness. In a seminal New England of Medicine article, he coined the term ‘iPatient’—the virtual construct of the patient in the computer—and made the point that the iPatient gets wonderful care all across America while the real patient in the bed can feel neglected, not getting both the information and the attention they hope for. In his presentation, Dr. Verghese, through anecdote, data and historical vignettes, tells the story of of physician burnout, of the incremental process that brought us here. He outlines the causes and challenges institutions to reverse the trend by addressing the roots causes and inefficiencies. For the individual physician in a changing and challenging time, he talks about faith, calling and the need for personal resilience and self-compassion while being advocates for change. Physician health and well-being has been taken for granted, but it more than ever critical for patients’ health outcomes, for the success of teams and institutions. To paraphrase the famous Peabody quote, the secret of good care resides in truly caring for the patient . . . and the physician.

All of us are living through the story of our lives. For each of us the story has played out at many levels: it is the story of our cells, our individual immune systems and vulnerabilities; it is the story of our families, our livelihood; the story has involved our towns, our cities, and our country, and it has played out on a backdrop of wildfires, floods, climate change and the great societal awakening to longstanding issues of racial equity. The story of COVID echoes the classic “monster” stories throughout history. It is instructive to consider the archetypal structure of such stories, especially the endings: we rarely ever return to things the way they were. Instead, we arrive at a new order, a new way of being. In this talk, Dr. Verghese explores the nature of courage, resilience and heroism. COVID has made heroes of all of us as we live through this extraordinary time. We are called to adventure whether we like to or not, forced to find armor, to find allies and special weapons, and to dig deep to find new resources within ourselves.

Modern medicine is in danger of losing a powerful, old-fashioned tool: human touch. Technological advances in medicine have equipped us with powerful tests and data, but these can become a crutch; we neglect the complex person in front of us and instead treat the “iPatient" on the screen. In this talk, Dr. Verghese argues that it’s time to refocus on the doctor-patient relationship and its foundation in the physical exam. A careful physical reveals as much as a battery of expensive tests at a fraction of the cost while also building trust between the caregiver and the patient. It puts the patient at the center of care and allows the doctor to use their most powerful diagnostic tool: the human hand. It’s the ritual that grounds Dr. Verghese’s vision of humanistic medicine in the modern age: care grounded in caring and the sanctity of the doctor-patient relationship.