a ritual of exceeding importance

These days, the only saving grace of the unsparing second year at medical school, amidst the endless succession of quizzes and problem sets and tests, is learning how to perform a physical exam. We had an exam today on how well we conduct a medical interview, communicate with the patient, and perform the cardiovascular and pulmonary exam -- what is considered to be the bread and butter of medicine. 

I joke to Jen that I should do the physical exam really well since I'm not smart enough to get good grades (oh wait, guess I'm not really joking about this), but I actually do enjoy the Doctoring sessions where they teach us how to perform a physical exam.

There is something very special about these exams -- I am doing something important with my own hands, yet it is not as invasive as surgeries. As much as I enjoyed observing surgeries in the O.R., watching doctors bringing palpable and dramatic treatment to a patient, I remember walking out of the O.R. once feeling somehow wronged. All the sterilizing, anesthesizing, cutting open, poking around, and scratching off, though perfectly well-meaning, are inherently traumatizing, bordering precariously on brutality. 

Physical exams, on the other hands, were different. Dr. Abraham Verghese, a Stanford medical professor and a renowned physician-writer, is an outspoken advocate for the restoration of the emphasis on physical exam in medicine. I wanted to share a few excerpts from his talk at a recent TED Conference, because he beautifully captures in words the value of a physical exam and the healing power of human touch between the doctor and the patient:

(In the year 2011) The patient in the bed has almost become an icon for the real patient who is in the computer. I call it the iPatient. The iPatient is getting wonderful care across America. The real patient often wonders, “Where is everyone? When are they going to come by and explain things to me?”

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When my ritual began, this very valuable patient began to quiet down. And I remember having a very eerie sense that the patient and I had somehow slipped back into a primitive ritual in which I had a role and the patient had a role. When I was done, the patient said to me with some awe, ‘I have never been examined like this before.’ […] Something of importance had transpired during that exchange.

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Rituals are all about transformation…The ritual of one individual coming to another and telling them things that they would not tell their preacher or rabbi, and, incredibly on top of that, disrobing and allowing touch – I would submit to you that that is a ritual of exceeding importance. 

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We seem to have drifted away, we seem to have forgotten…with the explosion of knowledge, the whole human genome mapped out at our feet, we are lulled into inattention, forgetting that the ritual is cathartic to the physician, necessary for the patient, forgetting that the ritual has meaning and a singular message to convey to the patient. A message, which I didn’t fully understand then, even as I delivered it, and which I understand better now, is this: I will always, always, always be there. I will see you through this, I will never abandon you, I will be with you through the end.