Abraham Verghese

It is that time of the year when fourth year medical students are gearing up to send in their applications for internships. I confess, for the first time in years, I sense that the choices are not clear.It used to be you could look into the crystal ball and paint a picture for them of what their life would look like when they were done: it used to be that if they chose primary care, they would probably over a lifetime make perhaps 3 to 5 million dollars less than…… More »

In a previous post I had worried that "Comparative Effectiveness Research" was going to be the sexy new buzz word, the one a fresh generation of physicians (particularly in academia) would adopt in just the way a previous generation made "EBM" (Evidence Based Medicine) their mantra. Well, I think I am coming around. When President Obama speaks about funding health reform, he keeps emphasizing that the money needed to achieve his goals of covering the uninsured, is…… More »

I had the pleasure of being in the East Wing of the White House on Wednesday, one of about 160 people in the audience as President Obama appeared on national television, fielding questions about health care. It was my first look at the President at close quarters. I came away with the impression that the President was possibly the most knowledgeable person in the room when it came to the current health care crisis. That's no small thing given the people who were…… More »

So I consider myself a dog person. Kind of. Had dogs when I was a kid, but my parents would never have dreamed of having them in the house. Then, when Sylvia and I got married, her dog was part of the package, an overweaned bitch answering to the name of Lady Chanel (the dog that is). To unbiased observers Lady Chanel was strange looking to say the least. … More »

President Obama's speech to the AMA was a model of reason, clarity and vision. It raises the question of why the AMA needed to be lectured about the dilemma a doctor, particularly one in primary care, faces: Our costly health care system is unsustainable for doctors like Michael Kahn in New Hampshire, who, as he puts it, spends 20 percent of each day supervising a staff explaining insurance problems to patients, completing authorization forms, and writing appeal…… More »

The most famous medical painting in the world is probably Sir Luke Fildes' THE DOCTOR. Fildes was inspired by the physician who attended his first born son, Philip, who, despite the doctor's efforts, died on Christmas Eve, 1877. When Fildes was later commissioned to produce a new work, he chose to portray "the doctor in our time." … More »

This month I am the attending physician overseeing an internal medicine team, one of four such teams that admit patients to my teaching hospital. It's a great time to be an attending physician. I have seasoned interns who in just a few weeks will be junior residents, and I have even more seasoned senior residents on their way to entering practice or entering subspecialty training. The team feels very efficient. What always strikes me when I come back to being on…… More »

A newsletter from our Stanford medical school library reminds me that fifteen years ago, if I wanted to get the latest scoop on a disease, I'd have had to walk through the stacks where our library displayed the 3,600 journal titles its owns. Then, once I collected the bound volumes containing the articles I wanted, it was off to the photocopier area. An hour later (provided my coins and the machine lasted), I'd be done.These days, my medical library (fittingly…… More »

The word "empathy" is getting interesting play these days. At times it even sounds like a pejorative. President Obama used the word frequently while campaigning and since being in office. In the context of choosing a Supreme Court nominee, he said that ideally such a person should understand Americans' problems and have empathy for their fellow beings. But he's also talked about empathy (in Atlanta in Jan 09) in the context of its absence: "We have an empathy…… More »

I began my internship in 1980 at a Veterans Administration hospital in Johnson City Tennessee--the Mountain Home VA. To this day I don't think I have seen a more beautiful campus with quaint brick buildings, lush lawns, dogwood lining the main avenue, and white southern mansions in which the doctors lived. But most beautiful and poignant was the cemetery, just to the right of the main entrance. Established in 1903 as a tribute to this corner of the "Volunteer"…… More »

John Sotos is a physician well known in medical circles for his book, ZEBRA CARDS: AN AID TO OBSCURE DIAGNOSIS. We tell our medical students, "When you hear hoofbeats think horses, not zebras," or, common things occur commonly. But John has had a lifelong interest in rare diseases--zebras. (He is also a medical consultant for the TV show HOUSE.)Recently, I heard John make the case in a lecture that Abraham Lincoln suffered from a rare endocrine disorder called…… More »

Sincere thanks for all the comments, and the healthy debate. Democracy and civil discourse at work! To respond to a few points from "A Concerned Physician" : Of course, I am all for preventive medicine! Drugs for hypertension to prevent stroke, Vit A for blindness. . . who could be against that.? But if you put forth the hypothesis that preventive care will SAVE money (as the President proposes) . . . well, I'm sorry to tell you that the evidence (yes, evidence!)…… More »

President Obama is in a bit of a bind, lets face it with his laudable goal to have health coverage for all uninsured Americans. The health care math is simple: we already spend a ton on health care and his goal will require spending more. His options are to generate new revenue, or the other option (the needed option, I would say) is to cut costs. But you saw what happened to Hilary years ago when she tried that. To quote from a great series of articles in the…… More »

I love medical riddles. (I don't mean the "Why-did-the-doctor-give-up-his-practice?" --"Because-he-lost-his-patien-ce!" kind of riddle). I mean the kind that one wrestles with, the kind that is instructive, a teacher's tool, a way to make the student reason, formulate hypotheses, go to the book, research and eliminate possibilities . . . and come to the answer. Such riddles have a hallowed place in medicine--I remember these riddles only because I was asked them…… More »

There are moments as a teacher when I'm conscious that I'm trotting out the same exact phrase my Professor used with me years ago. It's an eerie feeling, as if my old mentor is not just in the room, but in my shoes, using me as his mouthpiece. It happened yesterday when I was at the bedside, showing my students how to feel a patient's spleen which happened to be quite enlarged. Anyone can feel a big liver. Sitting as it does under the right lower ribs, the…… More »

In my previous post I used a phrase from a Lee Robinson poem that had the line "finding each other nose to nose." That prompted Bill to write: " . . . reminded me of visiting New Zealand for an international peroxidase meeting. The organizers had the opening ceremony follow Maori tradition (because we were on Maori land in Akaroa). The ceremony included singing etc, but with the Auslanders kept separate from the natives, divided by an imaginary line. We were not…… More »

In beginning this blog, I wanted to find a way to salute you the reader, to reach around your monitor and say hello. A poet friend, Lee Robinson, just sent me her new collection, "Creed" and she begins the book with the lines: "Shall we begin, you and I, two. strangers finding each other nose to. nose . . ." She's captured my sense of awe at this moment. For friends who know me, a blog must seem an improbable venture. After all, as a physician I have…… More »

On July 30 of last year a notorious Indian smuggler and poacher named Veerappan kidnapped an elderly and beloved Indian actor named Rajkumar and squirreled him away in a forest hideout. The ransom demands were political—and unacceptable. The kidnapping roiled India and churned an American-style media frenzy. Then, suddenly, in November, Rajkumar was set free, under circumstances fraught with mystery… More »