Abraham Verghese, MD, MACP

All Publications

• Medicine Is Not Gender-Neutral - She Is Male. The New England journal of medicine Lombarts, K. M., Verghese, A. 2022; 386 (13): 1284-1287

  View details for DOI 10.1056/NEJMms2116556

  View details for PubMedID 35353969

• Consultative Medicine - An Emerging Specialty for Patients with Perplexing Conditions. The New England journal of medicine Geng, L. N., Verghese, A., Tilburt, J. C. 1800; 385 (26): 2478-2484

  View details for DOI 10.1056/NEJMms2111017

  View details for PubMedID 34936744

• Courage in a climate of fear. Science translational medicine Verghese, A., Topol, E. 2020

  Abstract

  It is essential for physicians and scientists to speak up to counter misinformation about COVID-19 amid a culture of fear.

  View details for DOI 10.1126/scitranslmed.abf2461

  View details for PubMedID 33077677

• Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter. JAMA Zulman, D. M., Haverfield, M. C., Shaw, J. G., Brown-Johnson, C. G., Schwartz, R. n., Tierney, A. A., Zionts, D. L., Safaeinili, N. n., Fischer, M. n., Thadaney Israni, S. n., Asch, S. M., Verghese, A. n. 2020; 323 (1): 70–81

  Abstract

  Time constraints, technology, and administrative demands of modern medicine often impede the human connection that is central to clinical care, contributing to physician and patient dissatisfaction.To identify evidence and narrative-based practices that promote clinician presence, a state of awareness, focus, and attention with the intent to understand patients.Preliminary practices were derived through a systematic literature review (from January 1997 to August 2017, with a subsequent bridge search to September 2019) of effective interpersonal interventions; observations of primary care encounters in 3 diverse clinics (n = 27 encounters); and qualitative interviews with physicians (n = 10), patients (n = 27), and nonmedical professionals whose occupations involve intense interpersonal interactions (eg, firefighter, chaplain, social worker; n = 30). After evidence synthesis, promising practices were reviewed in a 3-round modified Delphi process by a panel of 14 researchers, clinicians, patients, caregivers, and health system leaders. Panelists rated each practice using 9-point Likert scales (-4 to +4) that reflected the potential effect on patient and clinician experience and feasibility of implementation; after the third round, panelists selected their "top 5" practices from among those with median ratings of at least +2 for all 3 criteria. Final recommendations incorporate elements from all highly rated practices and emphasize the practices with the greatest number of panelist votes.The systematic literature review (n = 73 studies) and qualitative research activities yielded 31 preliminary practices. Following evidence synthesis, 13 distinct practices were reviewed by the Delphi panel, 8 of which met criteria for inclusion and were combined into a final set of 5 recommendations: (1) prepare with intention (take a moment to prepare and focus before greeting a patient); (2) listen intently and completely (sit down, lean forward, avoid interruptions); (3) agree on what matters most (find out what the patient cares about and incorporate these priorities into the visit agenda); (4) connect with the patient's story (consider life circumstances that influence the patient's health; acknowledge positive efforts; celebrate successes); and (5) explore emotional cues (notice, name, and validate the patient's emotions).This mixed-methods study identified 5 practices that have the potential to enhance physician presence and meaningful connection with patients in the clinical encounter. Evaluation and validation of the outcomes associated with implementing the 5 practices is needed, along with system-level interventions to create a supportive environment for implementation.

  View details for DOI 10.1001/jama.2019.19003

  View details for PubMedID 31910284

• 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

• 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
• 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
• 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
• "The Art of the Craft," From The Covenant of Water. JAMA Verghese, A. 2023

  Abstract

  This Arts and Medicine feature excerpts a chapter from The Covenant of Water, the new novel from Abraham Verghese, which follows the lives of a family in South India over the 20th century who have a condition that consigns at least 1 member per generation to death by drowning.

  View details for DOI 10.1001/jama.2023.5899

  View details for PubMedID 37027151

• Past and present: Sir Ian Hill (1904-1982). A vignette. The journal of the Royal College of Physicians of Edinburgh Verghese, A. 2023: 14782715231161507

  Abstract

  Sir Ian Hill, who passed away in 1982, was a former President of the Royal College of Physicians of Edinburgh. His was an illustrious career, including a brief stint as Dean of the medical school in Addis Ababa, Ethiopia. The author, a current Fellow of the College describes a brief, yet life-changing encounter with Sir Ian as a student in Ethiopia.

  View details for DOI 10.1177/14782715231161507

  View details for PubMedID 36876634

• Teaching Anti-Racism in the Clinical Environment: The Five-Minute Moment for Racial Justice in Healthcare: Teaching anti-racism. The American journal of medicine Wang, S. X., Chi, K., Shankar, M., Israni, S. T., Verghese, A., Zulman, D. M. 2022

  Abstract

  Dismantling racism in health care demands that medical education promote racial justice throughout all stages of medical training. However, racial bias can be fostered unintentionally, influencing the way we make decisions as clinicians with downstream effects on patient health and health equity. The development of any anti-racism curriculum in medicine requires the ability to identify racial bias in practices we have not previously recognized as explicitly racist or unjust. This has limited the creation and delivery of effective antiracism education in healthcare.

  View details for DOI 10.1016/j.amjmed.2022.12.014

  View details for PubMedID 36566895

• A Randomized Clinical Trial to Evaluate an Atrial Fibrillation Stroke Prevention Shared Decision-Making Pathway. Journal of the American Heart Association Wang, P. J., Lu, Y., Mahaffey, K. W., Lin, A., Morin, D. P., Sears, S. F., Chung, M. K., Russo, A. M., Lin, B., Piccini, J., Hills, M. T., Berube, C., Pundi, K., Baykaner, T., Garay, G., Lhamo, K., Rice, E., Pourshams, I. A., Shah, R., Newswanger, P., DeSutter, K., Nunes, J. C., Albert, M. A., Schulman, K. A., Heidenreich, P. A., Bunch, T. J., Sanders, L. M., Turakhia, M., Verghese, A., Stafford, R. S. 2022: e8009

  Abstract

  Background Oral anticoagulation (OAC) reduces stroke and disability in atrial fibrillation (AF) but is underutilized. We evaluated the effects of a novel patient-clinician shared decision-making (SDM) tool in reducing OAC patient's decisional conflict as compared to usual care. Methods and Results We designed and evaluated a new digital decision aid in a multicenter, randomized, comparative effectiveness trial, ENHANCE-AF (Engaging Patients to Help Achieve Increased Patient Choice and Engagement for AF Stroke Prevention). The digital AF SDM Toolkit was developed using patient-centered design with clear health communication principles (e.g. meaningful images, limited text). Available in English and Spanish, the toolkit included the following: 1) a brief animated video; 2) interactive questions with answers; 3) a quiz to check on understanding; 4) a worksheet to be used by the patient during the encounter; and 5) an online guide for clinicians. The study population included English or Spanish speakers with non-valvular AF and a CHA2DS2-VASc stroke score ≥1 for men or ≥2 for women. Participants were randomized in a 1:1 ratio to either Usual Care (UC) or the SDM Toolkit. The primary endpoint was the validated 16-item Decisional Conflict Scale (DCS) at 1 month. Secondary outcomes included DCS at 6 months and the 10-item Decision Regret Scale (DRS) at 1 and 6 months as well as a weighted average of Mann-Whitney U-statistics for both DCS and DRS. A total of 1001 participants were enrolled and followed at 5 different sites in the United States between 12/18/19 and 8/17/22. The mean patient age was 69 ±10years (40% females, 16.9% Black, 4.5% Hispanic, 3.6% Asian), and 50% of participants had CHA2DS2-VASc scores ≥3 (M) or ≥4 (F). The primary endpoint at 1 month showed a clinically meaningful reduction in decisional conflict: a 7-point difference in median scores between the two arms (16.4 v 9.4; Mann-Whitney U-statistics=0.550; p-value=0.007). For the secondary endpoint of 1-month DRS, the difference in median scores between arms was 5 points in the direction of less decisional regret (p-value of 0.078). The treatment effects lessened over time: at 6 months the difference in medians was 4.7 points for DCS (p-value=0.060) and 0 points for DRS (p-value=0.35). Conclusions Implementation of a novel, Shared Decision-Making Toolkit (afibguide.com; afibguide.com/clinician) achieved significantly lower decisional conflict compared to usual care in patients with AF.

  View details for DOI 10.1161/JAHA.122.028562

  View details for PubMedID 36342828

• The Presence 5 for Racial Justice Framework for Anti-Racist Communication with Black Patients. Health services research Brown-Johnson, C., Cox, J., Shankar, M., Baratta, J., De Leon, G., Garcia, R., Hollis, T., Verano, M., Henderson, K., Upchurch, M., Safaeinili, N., Shaw, J. G., Fortuna, R. J., Beverly, C., Walsh, M., Somerville, C. S., Haverfield, M., Israni, S. T., Verghese, A., Zulman, D. M. 2022

  Abstract

  To identify communication practices that clinicians can use to address racism faced by Black patients, build trusting relationships, and empower Black individuals in clinical care.Qualitative data (N=112 participants, August 2020 to March 2021) collected in partnership with clinics primarily serving Black patients in Leeds, AL; Memphis, TN; Oakland, CA; and Rochester, NY.This multi-phased project was informed by human-centered design thinking and community-based participatory research principles. We mapped emergent communication and trust-building strategies to domains from the Presence 5 framework for fostering meaningful connection in clinical care.Interviews and focus group discussions explored anti-racist communication and patient-clinician trust (n=36 Black patients; n=40 non-medical professionals and n=24 clinicians of various races and ethnicities). The Presence 5 Virtual National Community Advisory Board guided analysis interpretation.The emergent Presence 5 for Racial Justice (P5RJ) practices include: 1) Prepare with intention by reflecting on identity, bias, and power dynamics; and creating structures to address bias and structural determinants of health; 2) Listen intently and completely without interruption and listen deeply for the potential impact of anti-Black racism on patient health and interactions with healthcare; 3) Agree on what matters most by having explicit conversations about patient goals, treatment comfort and consent, and referral planning; 4) Connect with the patient's story, acknowledging socioeconomic factors influencing patient health and focusing on positive efforts; 5) Explore emotional cues by noticing and naming patient emotions, and considering how experiences with racism might influence emotions.P5RJ provides a framework with actionable communication practices to address pervasive racism experienced by Black patients. Effective implementation necessitates clinician self-reflection, personal commitment, and institutional support that offers time and resources to elicit a patient's story and to address their needs.

  View details for DOI 10.1111/1475-6773.14015

  View details for PubMedID 35765147

• A Retrospective Analysis of Medical Student Performance Evaluations, 2014-2020: Recommend with Reservations. Journal of general internal medicine Tisdale, R. L., Filsoof, A. R., Singhal, S., Caceres, W., Nallamshetty, S., Rogers, A. J., Verghese, A. C., Harrington, R. A., Witteles, R. M. 2022

  Abstract

  BACKGROUND: The Medical Student Performance Evaluations (MSPE) is a cornerstone of residency applications. Little is known regarding adherence to Association of American Medical Colleges (AAMC) MSPE recommendations and longitudinal changes in MSPE content.OBJECTIVES: Evaluate current MSPE quality and longitudinal changes in MSPE and grading practices.DESIGN: Retrospective analysis.PARTICIPANTS: Students from all Liaison Committee on Medical Education (LCME)-accredited medical schools from which the Stanford University Internal Medicine residency program received applications between 2014-2015 and 2019-2020.MAIN MEASURES: Inclusion of key words to describe applicant performance and metrics thereof, including distribution among students and key word assignment explanation; inclusion of clerkship grades, grade distributions, and grade composition; and evidence of grade inflation over time.KEY RESULTS: MSPE comprehensiveness varied substantially among the 149 schools analyzed. In total, 25% of schools provided complete information consistent with AAMC recommendations regarding key word/categorization of medical students and clerkship grades in 2019-2020. Seventy-seven distinct key word terms appeared across the 139 schools examined in 2019-2020. Grading practices markedly varied, with 2-83% of students receiving the top internal medicine clerkship grade depending on the year and school. Individual schools frequently changed key word and grading practices, with 33% and 18% of schools starting and/or stopping use of key words and grades, respectively. Significant grade inflation occurred over the 6-year study period, with an average 14% relative increase in the proportion of students receiving top clerkship grades.CONCLUSIONS: A minority of schools complies with AAMC MSPE guidelines, and MSPEs are inconsistent across time and schools. These practices may impair evaluation of students within and between schools.

  View details for DOI 10.1007/s11606-022-07502-8

  View details for PubMedID 35710660

• Diagnosis and the Illness Experience: Ways of Knowing. JAMA Maitra, A., Verghese, A. 2021

  View details for DOI 10.1001/jama.2021.19496

  View details for PubMedID 34709354

• Using ethnographic methods to classify the human experience in medicine: a case study of the presence ontology. Journal of the American Medical Informatics Association : JAMIA Maitra, A., Kamdar, M. R., Zulman, D. M., Haverfield, M. C., Brown-Johnson, C., Schwartz, R., Israni, S. T., Verghese, A., Musen, M. A. 2021

  Abstract

  OBJECTIVE: Although social and environmental factors are central to provider-patient interactions, the data that reflect these factors can be incomplete, vague, and subjective. We sought to create a conceptual framework to describe and classify data about presence, the domain of interpersonal connection in medicine.METHODS: Our top-down approach for ontology development based on the concept of "relationality" included the following: 1) a broad survey of the social sciences literature and a systematic literature review of >20 000 articles around interpersonal connection in medicine, 2) relational ethnography of clinical encounters (n=5 pilot, 27 full), and 3) interviews about relational work with 40 medical and nonmedical professionals. We formalized the model using the Web Ontology Language in the Protege ontology editor. We iteratively evaluated and refined the Presence Ontology through manual expert review and automated annotation of literature.RESULTS AND DISCUSSION: The Presence Ontology facilitates the naming and classification of concepts that would otherwise be vague. Our model categorizes contributors to healthcare encounters and factors such as communication, emotions, tools, and environment. Ontology evaluation indicated that cognitive models (both patients' explanatory models and providers' caregiving approaches) influenced encounters and were subsequently incorporated. We show how ethnographic methods based in relationality can aid the representation of experiential concepts (eg, empathy, trust). Our ontology could support investigative methods to improve healthcare processes for both patients and healthcare providers, including annotation of videotaped encounters, development of clinical instruments to measure presence, or implementation of electronic health record-based reminders for providers.CONCLUSION: The Presence Ontology provides a model for using ethnographic approaches to classify interpersonal data.

  View details for DOI 10.1093/jamia/ocab091

  View details for PubMedID 34151988

• Virtual Care, Telemedicine Visits, and Real Connection in the Era of COVID-19: Unforeseen Opportunity in the Face of Adversity. JAMA Zulman, D. M., Verghese, A. 2021; 325 (5): 437–38

  View details for DOI 10.1001/jama.2020.27304

  View details for PubMedID 33528520

• International Medical Graduate Physician Deaths From COVID-19 in the United States. JAMA network open Dinakarpandian, D., Sullivan, K. J., Thadaney-Israni, S., Norcini, J., Verghese, A. 2021; 4 (6): e2113418

  View details for DOI 10.1001/jamanetworkopen.2021.13418

  View details for PubMedID 34115131

• Planning for the Known Unknown: Machine Learning for Human Healthcare Systems. The American journal of bioethics : AJOB Chen, J. H., Verghese, A. 2020; 20 (11): 1–3

  View details for DOI 10.1080/15265161.2020.1822674

  View details for PubMedID 33103968

• The Road Back to the Bedside. JAMA Elder, A., Chi, J., Ozdalga, E., Kugler, J., Verghese, A. 2020; 323 (17): 1672–73

  View details for DOI 10.1001/jama.2020.2764

  View details for PubMedID 32369130

• Writing Medicine. JAMA Verghese, A. 2020; 323 (17): 1649–50

  View details for DOI 10.1001/jama.2020.1488

  View details for PubMedID 32369113

• The power of touch LANCET Russell, S. W., Garibaldi, B. T., Elder, A., Verghese, A. 2020; 395 (10230): E63

  View details for Web of Science ID 000523580400002

• Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Zulman, D. M., Haverfield, M. C., Shaw, J. G., Brown-Johnson, C., Schwartz, R., Tierney, A. A., Zionts, D. L., Safaeinili, N., Fischer, M., Israni, S. T., Asch, S. M., Verghese, A. 2020; 323 (1): 70-81

  View details for DOI 10.1001/jama.2019.19003

• What is clinician presence? A qualitative interview study comparing physician and non-physician insights about practices of human connection. BMJ open Brown-Johnson, C., Schwartz, R., Maitra, A., Haverfield, M. C., Tierney, A., Shaw, J. G., Zionts, D. L., Safaeinili, N., Thadaney Israni, S., Verghese, A., Zulman, D. M. 2019; 9 (11): e030831

  Abstract

  OBJECTIVE: We sought to investigate the concept and practices of 'clinician presence', exploring how physicians and professionals create connection, engage in interpersonal interaction, and build trust with individuals across different circumstances and contexts.DESIGN: In 2017-2018, we conducted qualitative semistructured interviews with 10 physicians and 30 non-medical professionals from the fields of protective services, business, management, education, art/design/entertainment, social services, and legal/personal services.SETTING: Physicians were recruited from primary care clinics in an academic medical centre, a Veterans Affairs clinic, and a federally qualified health centre.PARTICIPANTS: Participants were 55% men and 45% women; 40% were non-white.RESULTS: Qualitative analyses yielded a definition of presence as a purposeful practice of awareness, focus, and attention with the intent to understand and connect with individuals/patients. For both medical and non-medical professionals, creating presence requires managing and considering time and environmental factors; for physicians in particular, this includes managing and integrating technology. Listening was described as central to creating the state of being present. Within a clinic, presence might manifest as a physician listening without interrupting, focusing intentionally on the patient, taking brief re-centering breaks throughout a clinic day, and informing patients when attention must be redirected to administrative or technological demands.CONCLUSIONS: Clinician presence involves learning to step back, pause, and be prepared to receive a patient's story. Building on strategies from physicians and non-medical professionals, clinician presence is best enacted through purposeful intention to connect, conscious navigation of time, and proactive management of technology and the environment to focus attention on the patient. Everyday practice or ritual supporting these strategies could support physician self-care as well as physician-patient connection.

  View details for DOI 10.1136/bmjopen-2019-030831

  View details for PubMedID 31685506

• Protecting the Sanctity of the Patient-Physician Relationship. JAMA Harman, S., Verghese, A. 2019

  View details for DOI 10.1001/jama.2019.17965

  View details for PubMedID 31661114

• 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

• 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. The American journal of medicine Hall, E. T., Weaver, K. W., Perino, A. C., Elder, A., Verghese, A. 2018

  View details for PubMedID 29680486

• 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

• 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

• 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

• 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

• 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

• 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

• The Physical Exam and Other Forms of Fiction J Gen Intern Med Kugler J, Verghese A 2010
• 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

• 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