If We Can't Measure It, It Doesn't Exist

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2898183014_7148fd4f21.jpgI am at the First Stanford Symposium on Bedside Medicine, and we have the world's leading experts on the diagnostic examination gathered here.  It is a small group who still believe there is value in examining the patient, even in this era of imaging and technology.

An anthropologist from Mars looking at our hospitals might conclude that the 'work' of medicine takes place in rooms far removed from the patient, typically in front of a computer screen. The actual patient and the person-hood of the patient is pushed to the margin of medical attention while the 'iPatient', the virtual patient rules.

Last night we talked about the ritual of the exam, and how important that ritual is. Rituals are about transformation, and the careful exam has all the elements of ritual, including a sacred space, a ceremonial garb (white coat and patient gown), a routine that is mysterious to the patient and includes disrobing and touch (which in any other context would be assault). Rituals are about transformation (think wedding, baptism etc) and this ritual when done well, is transformative, it establishes the physician-patient bond, it recognizes the body of the patient (the soma as opposed to the image of the body), and it is therapeutic, particularly in chronic disease, where the ritual repeated at every visit conveys to the patient that we are with them on the journey, we will not abandon them.

Everyone agreed to this aspect of the exam, the importance of ritual.  Then why is it that we so rarely emphasize the importance of the ritual when trying to defend and preserve what is a threatened craft? I think it is because this ritual (like love, steadfastness, loyalty, courage) is not easily measured, and in a medical world that seems to be ruled by psychometricians, if it ain't measured it doesn't exist.

But hope springs eternal, and this little group is determined to bring about change.

(Photo: Flickr User mynameisharsha)

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Abraham Verghese is an author, physician and med school professor. He is the author of Cutting for Stone and his writing has appeared in many major publications. More

Abraham Verghese is a physician and writer. His third book and first novel, Cutting for Stone, was published by Knopf in 2009. He is also known for two acclaimed non-fiction works, My Own Country, which was based on his experiences working with persons living with HIV in Johnson City, Tennessee; that book was a finalist for the National Book Critics Circle award and was made into a movie. He followed that with The Tennis Partner, also a New York Times notable book and a national bestseller. His writing has appeared in The Atlantic, The New Yorker, The New York Times , The New York Times Magazine, Sports Illustrated, and The Wall Street Journal as well as many medical journals. Verghese is board-certified in internal medicine, pulmonary medicine and infectious diseases. He attended the Iowa Writers Workshop at the University of Iowa where he earned his MFA. He currently practices and teaches at Stanford University School of Medicine where he is a tenured Professor and Senior Associate Chair for the Theory and Practice of Medicine in the Department of Internal Medicine.
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