High-Touch Care in a High-Tech Era

SAN FRANCISCO, CA - Twenty-first Century medicine is awash in technological advancements that allow physicians to see and know more about their patients than ever before.

Thanks to technology, PET scans can provide three-dimensional pictures of body's functional processes, human DNA sequencing has been decoded and physicians have a range of complicated testing at their fingertips which can generate volumes of extraordinary patient data to aid in diagnosing and treating disease.

But that provides medicine and health care providers with a 21st Century challenge, says Dr. Abraham Verghese, vice chair for the Theory and Practice of Medicine at the School of Medicine at Stanford University.

Verghese's remarks came during the opening session of Dignity Health's Compassion & Healthcare Conference in San Francisco. The event was part of a weeklong series of seminars focused on advancing compassion in health care and the scientific and academic study and discovery related to compassion and well being.

The values of compassion and kindness have become the "beacon of light" that guide all that Dignity Health seeks to do, Lloyd Dean, the company's president and CEO said in opening the conference. This is evidenced in programs and policies that include recognizing and honoring a patient's spiritual needs, and ensuring that no patient is alone when gravely ill, Dean said.

"When brought together and when we focus our resources, our minds and our beings, it is compassion and kindness that are the two things we know can make a difference," Dean said. "It is still, in 2014, the human touch, the human connection and the power of listening that really helps heal."

But just how do health care professionals keep the "care" in health care at a time when doctors and nurses typically spend more time in front of computer terminals than patients?

One way, Verghese suggests, is by hanging on to the traditional, Samaritan function of medicine.

"I would argue that there is still an incredible need for us to be at the bedside and for us to be examining the patient," he said.

Verghese make his argument with what he calls the three Ps: The phenotype issue, the purposeful ritual, and patient/physician satisfaction.

Despite the importance of data and testing, a patient's phenotype, or how they look to you as the care provider, really counts, he says.

"When I see a patient walk in and I can spot the outline of a pack of cigarettes in their shirt pocket, I already know a lot more about them than the genotype will ever tell me," he says. "I know about their risk for sudden death. I know about their risk for coronary artery disease, I know about their risk for lung cancer and COPD."

That initial assessment leads seamlessly into the standard physical, which Verghese says is an important, purposeful ritual that all of us associate with seeking medical care.

The physical exam allows for an important critical opportunity of observation that high tech testing can't replace, he says.

It also preserves the personality of the patient and validates the patient's complaints as being on the body, not in some image generated as part of a test, Verghese said.

Verghese's final "P," patient/physician satisfaction, stems directly from the execution of the ritual exam. Both the patient and physician are more fulfilled in the experience of receiving and delivering care when the ritual is performed with care an attention, he notes, yet in dozens of letters from patients he hears that their care provider "did not touch me, or he or she did not lay a hand on me," he said.

"The metaphor of contact and connection seem terribly important to the patient and should seem so self-evident if you have been a patient yourself," he said.

"The care of the patient does in fact, require the care of the patient," Verghese said. "And none of the science and technology can substitute for that touch of one individual connection with the soul of another."