Vital Times 2019 - 81

averaged 4000 mouse clicks over a 10-hour shift, and
spent 43 percent of their time on data entry but only
28 percent in direct patient contact.

merchants would tap on casks of wine to check their
fullness. He invented the art of percussion, and in
1816, Dr. René Laennec invented the stethoscope.

"The electronic health record was never designed
for us to use," Dr. Verghese said. "It was designed
for billing. The current electronic health record is a
mistake of epic proportions. We are the highest-paid
clerical workers in the world!"

"The day when physicians began to carry the
stethoscope in their pockets was the moment where
we were no longer in the tradition of the barbersurgeons," Dr. Verghese explained. The barbersurgeons made no attempt at diagnosis, they merely
"cut, purged, and burned," no matter what the
underlying disease happened to be.

The physician who inspired Sherlock
Holmes
Dr. Verghese opened his talk with a story he loves to
tell medical students about Dr. Joseph Bell, a surgeon
who was the instructor of Arthur Conan Doyle when
Doyle studied medicine in Edinburgh, Scotland. Dr.
Bell was the apparent inspiration for Doyle's famous
character, Detective Sherlock Holmes. Seeing a
patient in clinic for the first time, Dr. Bell could tell
by her accent what part of Scotland she had traveled
from, by the clay on her shoes that she had walked
through the Botanical Gardens on the way to the
clinic, and by the dermatitis on her hand that she
worked at a linoleum factory.
With Dr. Bell's remarkable observation skills, Dr.
Verghese said, "can you imagine how much the
body is going to speak to him after the patient has
disrobed?"
Dr. Verghese traced the art of physical diagnosis back
to the early 18th century, when Dr. Josef Leopold
Auenbrugger, a physician in Vienna, conceived
the idea of tapping on a patient's chest to assess
fluid levels around the heart and lungs just as wine

Though our ability to diagnose and treat disease has
advanced exponentially, and we can amass staggering
amounts of "Big Data" about patients, Dr. Verghese
made the case that the heart of practicing medicine
is in danger of being lost because of disconnection
between physician and patient.
Dr. Verghese showed a photograph of the great
physician and teacher Sir William Osler, sitting at
a patient's bedside, clearly in deep contemplation.
Next, he showed a famous 1891 painting by Luke
Fildes called "The Doctor," which shows a physician
watching at the bedside of a dying child. Fildes
painted from his own experience, after a physician
kept vigil with his nine-year-old son for two days
and two nights before the child finally died from an
untreatable illness.
"Even though this was the era of the stethoscope,
Fildes did not include any of those in the painting,"
Dr. Verghese noted. "Why this painting has such
public appeal - we identify with the child. This
is the singular attentiveness we want from our
physicians."

Annual Publication 2019 | 81

Vital Times 2019

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