Abraham Verghese, MD, MACP

All Publications

• Transdisciplinary Strategies for Physician Wellness: Qualitative Insights from Diverse Fields Journal of General Internal Medicine Schwartz, R., Haverfield, M. C., Brown-Johnson, C., Maitra, A., Tierney, A., Bharadwaj, S., Shaw, J. G., Azimpour, F., Thadaney Israni, S., Verghese, A., Zulman, D. M. 2019

  Abstract

  While barriers to physician wellness have been well detailed, concrete solutions are lacking.We looked to professionals across diverse fields whose work requires engagement and interpersonal connection with clients. The goal was to identify effective strategies from non-medical fields that could be applied to preserve physician wellness.We conducted semi-structured interviews with 30 professionals outside the field of clinical medicine whose work involves fostering effective connections with individuals.Professionals from diverse professions, including the protective services (e.g., police officer, firefighter), business/finance (e.g., restaurateur, salesperson), management (e.g., CEO, school principal), education, art/design/entertainment (e.g., professional musician, documentary filmmaker), community/social services (e.g., social worker, chaplain), and personal care/services (e.g., massage therapist, yoga instructor).Interviews covered strategies that professionals use to initiate and maintain relationships, practices that cultivate professional fulfillment and preserve wellness, and techniques that facilitate emotional presence during interactions. Data were coded using an inductive thematic analysis approach.Professionals identified self-care strategies at both institutional and individual levels that support wellness. Institutional-level strategies include scheduling that allows for self-care, protected time to connect with colleagues, and leadership support for debriefing after traumatic events. Individual strategies include emotionally protective distancing techniques and engagement in a bidirectional exchange that is central to interpersonal connection and professional fulfillment.In this exploratory study, the purposive sampling technique and single representative per occupation could limit the generalizability of findings.Across diverse fields, professionals employ common institutional and personal wellness strategies that facilitate meaningful engagement, support collegiality, and encourage processing after intense events. The transdisciplinary nature of these wellness strategies highlights universal underpinnings that support wellbeing in those engaging in people-oriented professions.

  View details for DOI 10.1007/s11606-019-04913-y

• Transdisciplinary Strategies for Physician Wellness: Qualitative Insights from Diverse Fields. Journal of general internal medicine Schwartz, R., Haverfield, M. C., Brown-Johnson, C., Maitra, A., Tierney, A., Bharadwaj, S., Shaw, J. G., Azimpour, F., Thadaney Israni, S., Verghese, A., Zulman, D. M. 2019

  Abstract

  While barriers to physician wellness have been well detailed, concrete solutions are lacking.We looked to professionals across diverse fields whose work requires engagement and interpersonal connection with clients. The goal was to identify effective strategies from non-medical fields that could be applied to preserve physician wellness.We conducted semi-structured interviews with 30 professionals outside the field of clinical medicine whose work involves fostering effective connections with individuals.Professionals from diverse professions, including the protective services (e.g., police officer, firefighter), business/finance (e.g., restaurateur, salesperson), management (e.g., CEO, school principal), education, art/design/entertainment (e.g., professional musician, documentary filmmaker), community/social services (e.g., social worker, chaplain), and personal care/services (e.g., massage therapist, yoga instructor).Interviews covered strategies that professionals use to initiate and maintain relationships, practices that cultivate professional fulfillment and preserve wellness, and techniques that facilitate emotional presence during interactions. Data were coded using an inductive thematic analysis approach.Professionals identified self-care strategies at both institutional and individual levels that support wellness. Institutional-level strategies include scheduling that allows for self-care, protected time to connect with colleagues, and leadership support for debriefing after traumatic events. Individual strategies include emotionally protective distancing techniques and engagement in a bidirectional exchange that is central to interpersonal connection and professional fulfillment.In this exploratory study, the purposive sampling technique and single representative per occupation could limit the generalizability of findings.Across diverse fields, professionals employ common institutional and personal wellness strategies that facilitate meaningful engagement, support collegiality, and encourage processing after intense events. The transdisciplinary nature of these wellness strategies highlights universal underpinnings that support wellbeing in those engaging in people-oriented professions.

  View details for PubMedID 31037542

• Humanizing Artificial Intelligence JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Israni, S., Verghese, A. 2019; 321 (1): 29–30

  View details for DOI 10.1001/jama.2018.19398

  View details for Web of Science ID 000455606000007

• Humanizing Artificial Intelligence. JAMA Israni, S. T., Verghese, A. 2018

  View details for PubMedID 30535297

• 'A Man Walks Into a Bar': Riddles in the Teaching of Medicine AMERICAN JOURNAL OF MEDICINE Hall, E. T., Weaver, K. W., Perino, A. C., Elder, A., Verghesc, A. 2018; 131 (9): 1000–1002

  View details for DOI 10.1016/j.amjmed.2018.03.033

  View details for Web of Science ID 000445642300026

• The Physical Examination as Una tor Ritual Social Sciences and Embodiment in the Context of the Physical Examination MEDICAL CLINICS OF NORTH AMERICA Costanzo, C., Verghese, A. 2018; 102 (3): 425-+

  Abstract

  The privilege of examining a patient is a skill of value beyond its diagnostic utility. A thorough physical examination is an important ritual that benefits patients and physicians. The concept of embodiment helps one understand how illness and pain further define and shape the lived experiences of individuals in the context of their race, gender, sexuality, and socioeconomic status. Understanding ritual in medicine, including the placebo effects of such rituals, reaffirms the centrality of the physical examination to the process of building strong physician-patient relationships.

  View details for PubMedID 29650064

• "A Man Walks Into a Bar": Riddles in the Teaching of Medicine. The American journal of medicine Hall, E. T., Weaver, K. W., Perino, A. C., Elder, A., Verghese, A. 2018

  View details for PubMedID 29680486

• FOSTERING PATIENT-PROVIDER CONNECTION DURING CLINICAL ENCOUNTERS: INSIGHTS FROM NON-MEDICAL PROFESSIONALS Schwartz, R., Brown-Johnson, C., Haverfield, M. C., Tierney, A. A., Bharadwaj, S., Zionts, D. L., Romero, I., Piccininni, G., Shaw, J. G., Thadaney, S., Azimpour, F., Verghese, A., Zulman, D. M. SPRINGER. 2018: S200

  View details for Web of Science ID 000442641400264

• My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS Simon & Schuster, New York, NY 1994. Verghese A
• The Tennis Partner: A Doctor's Story of Friendship and Loss 1998 Aug. (Harper Collins in the USA, Vintage in the UK, Penguin in India). 1999 Oct Paperback version (by Harper Perennial in the USA and Vintage in UK) Verghese A
• What This Computer Needs Is a Physician Humanism and Artificial Intelligence JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Verghese, A., Shah, N. H., Harrington, R. 2018; 319 (1): 19–20

  View details for PubMedID 29261830

• THE SEEDS OF LIFE From Aristotle to da Vinci, From Sharks' Teeth to Frogs' Pants, the Long and Strange Quest to Discover Where Babies Come From (Book Review) NEW YORK TIMES BOOK REVIEW Book Review Authored by: Verghese, A. 2017; 122 (26): 16

  View details for Web of Science ID 000404093900022

• Making mindset matter. BMJ (Clinical research ed.) Crum, A. J., Leibowitz, K. A., Verghese, A. 2017; 356: j674-?

  View details for DOI 10.1136/bmj.j674

  View details for PubMedID 28202443

• Annals for Hospitalists Inpatient Notes - Rituals in Chaos, the Sacred in the Profane. Annals of internal medicine Hosamani, P., Verghese, A. 2017; 166 (2): HO2-?

  View details for DOI 10.7326/M16-2737

  View details for PubMedID 28114474

• The Value of Physical Examination: A New Conceptual Framework SOUTHERN MEDICAL JOURNAL Zaman, J., Verghese, A., Elder, A. 2016; 109 (12): 754-757

  Abstract

  The physical examination defines medical practice, yet its role is being questioned increasingly, with statistical comparisons of diagnostic accuracy often the sole metric used against newer technologies. We set out to highlight seven ways in which the physical examination has value beyond diagnostic accuracy to reaffirm its place in the core skills of a physician and guide future research, teaching, and curriculum design. We show that this more comprehensive approach to the physical examination of its "utility" beyond that of reaching a diagnosis can be beneficial to both doctor and patient.

  View details for DOI 10.14423/SMJ.0000000000000573

  View details for PubMedID 27911967

• Bedside Medicine: Back to the Future? SOUTHERN MEDICAL JOURNAL Elder, A., Verghese, A. 2016; 109 (12): 736–37

  View details for DOI 10.14423/SMJ.0000000000000574

  View details for Web of Science ID 000389799300002

  View details for PubMedID 27911962

• Meaning and the Nature of Physicians' Work NEW ENGLAND JOURNAL OF MEDICINE Rosenthal, D. I., Verghese, A. 2016; 375 (19): 1813–15

  View details for PubMedID 27959650

• Accreditation Council for Graduate Medical Education (ACGME) Milestones-Time for a Revolt? JAMA internal medicine Witteles, R. M., Verghese, A. 2016; 176 (11): 1599-1600

  View details for DOI 10.1001/jamainternmed.2016.5552

  View details for PubMedID 27668812

• The Importance Of Being. Health affairs Verghese, A. 2016; 35 (10): 1924-1927

  Abstract

  Good patient care is found not on a computer screen but in being truly present with patients.

  View details for PubMedID 27702966

• Evolutionary Pressures on the Electronic Health Record: Caring for Complexity. JAMA Zulman, D. M., Shah, N. H., Verghese, A. 2016; 316 (9): 923-924

  View details for DOI 10.1001/jama.2016.9538

  View details for PubMedID 27532804

• The Five-Minute Moment. American journal of medicine Chi, J., Artandi, M., Kugler, J., Ozdalga, E., Hosamani, P., Koehler, E., Osterberg, L., Zaman, J., Thadaney, S., Elder, A., Verghese, A. 2016; 129 (8): 792-795

  Abstract

  In today's hospital and clinic environment, the obstacles to bedside teaching both for faculty and trainees are considerable. As Electronic Health Records (EHR) systems become increasingly prevalent, trainees are spending more time performing patient care tasks from computer workstations, limiting opportunities to learn at the bedside. Physical examination skills are rarely emphasized and low confidence levels, especially in junior faculty, pose additional barriers to teaching the bedside exam.

  View details for DOI 10.1016/j.amjmed.2016.02.020

  View details for PubMedID 26972793

• Inadequacies of 'Inadequacies of Physical Examination' Reply AMERICAN JOURNAL OF MEDICINE Verghese, A., Charlton, B., Kassirer, J. P., Ramsey, M., Ioannidis, J. A. 2016; 129 (7): E85

  View details for PubMedID 27320713

• I Carry Your Heart. JAMA cardiology Verghese, A. 2016; 1 (2): 213-215

  View details for DOI 10.1001/jamacardio.2015.0353

  View details for PubMedID 27437895

• How valuable is physical examination of the cardiovascular system? BMJ (Clinical research ed.) Elder, A., Japp, A., Verghese, A. 2016; 354: i3309-?

  Abstract

  Physical examination of the cardiovascular system is central to contemporary teaching and practice in clinical medicine. Evidence about its value focuses on its diagnostic accuracy and varies widely in methodological quality and statistical power. This makes collation, analysis, and understanding of results difficult and limits their application to daily clinical practice. Specific factors affecting interpretation and clinical application include poor standardisation of observers' technique and training, the study of single signs rather than multiple signs or signs in combination with symptoms, and the tendency to compare physical examination directly with technological aids to diagnosis rather than explore diagnostic strategies that combine both. Other potential aspects of the value of physical examination, such as cost effectiveness or patients' perceptions, are poorly studied. This review summarises the evidence for the clinical value of physical examination of the cardiovascular system. The best was judged to relate to the detection and evaluation of valvular heart disease, the diagnosis and treatment of heart failure, the jugular venous pulse in the assessment of central venous pressure, and the detection of atrial fibrillation, peripheral arterial disease, impaired perfusion, and aortic and carotid disease. Although technological aids to diagnosis are likely to become even more widely available at the point of care, the evidence suggests that further research into the value of physical examination of the cardiovascular system is needed, particularly in low resource settings and as a potential means of limiting inappropriate overuse of technological aids to diagnosis.

  View details for DOI 10.1136/bmj.i3309

  View details for PubMedID 27598000

• Inadequacies of Physical Examination as a Cause of Medical Errors and Adverse Events: A Collection of Vignettes. American journal of medicine Verghese, A., Charlton, B., Kassirer, J. P., Ramsey, M., Ioannidis, J. P. 2015; 128 (12): 1322-1324 e3

  Abstract

  Oversights in the physical examination are a type of medical error not easily studied by chart review. They may be a major contributor to missed or delayed diagnosis, unnecessary exposure to contrast and radiation, incorrect treatment, and other adverse consequences. Our purpose was to collect vignettes of physical examination oversights and to capture the diversity of their characteristics and consequences.A cross-sectional study using an 11-question qualitative survey for physicians was distributed electronically, with data collected from February to June of 2011. The participants were all physicians responding to e-mail or social media invitations to complete the survey. There were no limitations on geography, specialty, or practice setting.Of the 208 reported vignettes that met inclusion criteria, the oversight was caused by a failure to perform the physical examination in 63%; 14% reported that the correct physical examination sign was elicited but misinterpreted, whereas 11% reported that the relevant sign was missed or not sought. Consequence of the physical examination inadequacy included missed or delayed diagnosis in 76% of cases, incorrect diagnosis in 27%, unnecessary treatment in 18%, no or delayed treatment in 42%, unnecessary diagnostic cost in 25%, unnecessary exposure to radiation or contrast in 17%, and complications caused by treatments in 4%. The mode of the number of physicians missing the finding was 2, but many oversights were missed by many physicians. Most oversights took up to 5 days to identify, but 66 took longer. Special attention and skill in examining the skin and its appendages, as well as the abdomen, groin, and genitourinary area could reduce the reported oversights by half.Physical examination inadequacies are a preventable source of medical error, and adverse events are caused mostly by failure to perform the relevant examination.

  View details for DOI 10.1016/j.amjmed.2015.06.004

  View details for PubMedID 26144103

• BAD FAITH When Religious Belief Undermines Modern Medicine (Book Review) NEW YORK TIMES BOOK REVIEW Book Review Authored by: Verghese, A. 2015; 120 (15): 14

  View details for Web of Science ID 000352675700017

• Clinical education and the electronic health record: the flipped patient. JAMA Chi, J., Verghese, A. 2014; 312 (22): 2331-2332

  View details for DOI 10.1001/jama.2014.12820

  View details for PubMedID 25490318

• KNOCKING ON HEAVEN'S DOOR The Path to a Better Way of Death (Book Review) NEW YORK TIMES BOOK REVIEW Book Review Authored by: Verghese, A. 2013: 21–22

  View details for Web of Science ID 000326129500018

• A piece of my mind. The road back to the bedside. JAMA-the journal of the American Medical Association Elder, A., Chi, J., Ozdalga, E., Kugler, J., Verghese, A. 2013; 310 (8): 799-800

  View details for DOI 10.1001/jama.2013.227195

  View details for PubMedID 23982364

• Attending Physicians on Ward Rounds Reply JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Wachter, R. M., Verghese, A. C. 2013; 309 (4): 341-341

  View details for Web of Science ID 000313799000014

  View details for PubMedID 23340628

• The Attending Physician on the Wards Finding a New Homeostasis JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Wachter, R. M., Verghese, A. 2012; 308 (10): 977-978

  View details for Web of Science ID 000308579300017

  View details for PubMedID 22968883

• The Bedside Evaluation: Ritual and Reason ANNALS OF INTERNAL MEDICINE Verghese, A., Brady, E., Kapur, C. C., Horwitz, R. I. 2011; 155 (8): 550-U125

  Abstract

  The bedside evaluation, consisting of the history and physical examination, was once the primary means of diagnosis and clinical monitoring. The recent explosion of imaging and laboratory testing has inverted the diagnostic paradigm. Physicians often bypass the bedside evaluation for immediate testing and therefore encounter an image of the patient before seeing the patient in the flesh. In addition to risking delayed or missed diagnosis of readily recognizable disease, physicians who forgo or circumvent the bedside evaluation risk the loss of an important ritual that can enhance the physician-patient relationship. Patients expect that some form of bedside evaluation will take place when they visit a physician. When physicians complete this evaluation in an expert manner, it can have a salutary effect. If done poorly or not at all, in contrast, it can undermine the physician-patient relationship. Studies suggest that the context, locale, and quality of the bedside evaluation are associated with neurobiological changes in the patient. Recognizing the importance of the bedside evaluation as a healing ritual and a powerful diagnostic tool when paired with judicious use of technology could be a stimulus for the recovery of an ebbing skill set among physicians.

  View details for DOI 10.1059/0003-4819-155-8-201110180-00013

  View details for PubMedID 22007047

• Internal Medicine Residency Redesign: Proposal of the Internal Medicine Working Group AMERICAN JOURNAL OF MEDICINE Horwitz, R. I., Kassirer, J. P., Holmboe, E. S., Humphrey, H. J., Verghese, A., Croft, C., Kwok, M., Loscalzo, J. 2011; 124 (9): 806-812

  Abstract

  Concerned with the quality of internal medicine training, many leaders in the field assembled to assess the state of the residency, evaluate the decline in interest in the specialty, and create a framework for invigorating the discipline. Although many external factors are responsible, we also found ourselves culpable: allowing senior role models to opt out of important training activities, ignoring a progressive atrophy of bedside skills, and focusing on lock-step curricula, lectures, and compiled diagnostic and therapeutic strategies. The group affirmed its commitment to a vision of internal medicine rooted in science and learned with mentors at the bedside. Key factors for new emphasis include patient-centered small group teaching, greater incorporation of clinical epidemiology and health services research, and better schedule control for trainees. Because previous proposals were weakened by lack of evidence, we propose to organize the Cooperative Educational Studies Group, a pool of training programs that will collect a common data set describing their programs, design interventions to be tested rigorously in multi-methodological approaches, and at the same time produce knowledge about high-quality practice.

  View details for DOI 10.1016/j.amjmed.2011.03.007

  View details for Web of Science ID 000294043100019

  View details for PubMedID 21854887

• ONE HUNDRED NAMES FOR LOVE A Stroke, a Marriage, and the Language of Healing (Book Review) NEW YORK TIMES BOOK REVIEW Book Review Authored by: Verghese, A. 2011: 14-14

  View details for Web of Science ID 000289337200013

• A history of physical examination texts and the conception of bedside diagnosis. Transactions of the American Clinical and Climatological Association Verghese, A., Charlton, B., Cotter, B., Kugler, J. 2011; 122: 290-311

  View details for PubMedID 21686233

• SALVATION CITY (Book Review) NEW YORK TIMES BOOK REVIEW Book Review Authored by: Verghese, A. 2010: 9-9

  View details for Web of Science ID 000282475500010

• LONG FOR THIS WORLD The Strange Science of Immortality (Book Review) NEW YORK TIMES BOOK REVIEW Book Review Authored by: Verghese, A. 2010: 10-10

  View details for Web of Science ID 000280246000013

• The Physical Exam and Other Forms of Fiction JOURNAL OF GENERAL INTERNAL MEDICINE Kugler, J., Verghese, A. 2010; 25 (8): 756-757

  View details for DOI 10.1007/s11606-010-1400-3

  View details for Web of Science ID 000279505300002

  View details for PubMedID 20502975

  View details for PubMedCentralID PMC2896585

• The Physical Exam and Other Forms of Fiction J Gen Intern Med Kugler J, Verghese A 2010
• Caring for Ivan Ilyich JOURNAL OF GENERAL INTERNAL MEDICINE Charlton, B., Verghese, A. 2010; 25 (1): 93-95

  Abstract

  For over a century, Leo Tolstoy's The Death of Ivan Ilych has been one of the most influential examinations of how we come to terms with our own mortality. Of the many who care for Ivan Ilych, only the uneducated peasant, Gerasim, is able to help him find meaning and resolution before death. An excerpt that describes Gerasim's key interaction with Ivan Ilych is provided. Analysis of the text reveals how cultural values may hinder a patient's ability to confront mortality and how unique social barriers inhibit different caretakers' ability to care for a dying patient.

  View details for DOI 10.1007/s11606-009-1177-4

  View details for PubMedID 20016955

• Cutting for Stone A novel published by Vintage Books Edition, NY Verghese A 2010
• Caring for Ivan Ilyich J Gen Intern Med Charlton B, Verghese A 2010; 25 (1): 93-5
• Christmas 2009 In praise of the physical examination BRITISH MEDICAL JOURNAL Verghese, A., Horwitz, R. I. 2009; 339

  View details for DOI 10.1136/bmj.b5448

  View details for Web of Science ID 000272930300020

• A Touch Of Sense HEALTH AFFAIRS Verghese, A. 2009; 28 (4): 1177-1182

  View details for DOI 10.1377/hlthaff.28.4.1177

  View details for PubMedID 19597219

• Cutting for Stone A novel published by Alfred P. Knopf, NY Verghese A 2009
• Learning bedside medicine. The virtual mentor : VM Kugler, J., Verghese, A. 2009; 11 (11): 900-903

  View details for DOI 10.1001/virtualmentor.2009.11.11.mnar1-0911

  View details for PubMedID 23207007

• In Praise of the Physical Examination British Medical Journal Verghese A, Horwitz RI 2009; 339: 5448
• A touch of sense "Health Affairs Verghese A 2009; 24 (8): 1177-82
• Culture Shock - Patient as Icon, Icon as Patient NEW ENGLAND JOURNAL OF MEDICINE Verghese, A. 2008; 359 (26): 2748-2751

  View details for PubMedID 19109572

• Culture Shock: The Patient as Icon, Icon as Patient New England Journal of Medicine Verghese A 2008; 359 (26): 2748-51
• The Calling New England Journal of Medicine Verghese A 2005; 352 (18): 1844-7