RSNA 2019: Abraham Verghese, MD, Connects Specialties

RSNA 2019 attendees wishing to see radiology through the eyes of an astute nonradiologist will find what they’re looking for when Abraham Verghese, MD, takes the mic at the opening session. 

The renowned Stanford educator and infectious-disease expert—the peaks of whose multidirectional career include writing bestsellers, receiving the National Humanities Medal from President Barack Obama and, more recently, founding the Stanford Presence Center (look it up)—is to speak on “Finding the Caring in Care.” 

In a phone interview with RBJ, Verghese stressed that caring “extends back to us caring for each other as colleagues.” He reflected on the days when collaborating with radiologists often meant walking to the reading room for face-to-face consults. “There’s nothing like going down there and really framing the context of your clinical question and getting the answer in person,” he said. “You feel more fully informed.” 

Here’s more from the conversation.

How will you tailor your patient-first perspective at RSNA to radiologists, many of whom are pure diagnosticians with very little direct patient contact? 

We have to remind ourselves of our shared ancestry. As physicians we start off in the same place before branching off into specialties. Over time we can become even more specialized, more narrow in our focus. Some in radiology may have very little patient contact, but others have a great deal. I think the nature of where healthcare is heading makes it much more important for us all to look outside our fields more and more. This is as important in radiology as it is elsewhere. We work as teams, and the care is expressed through the system as a whole. 

One of the reasons to talk about finding the care in caring is that we might perhaps all need to get away from the old paradigms, say, of radiologists working with images in isolation and not with patients. Many of my interventional colleagues are very involved in patient care and often what they do is pivotal to the patient experience.

It all points back to that famous quote from Dr. Francis Peabody of almost 100 years ago: “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.” If our focus remains the care of the patient, none of us can see ourselves as purely diagnosticians or medical scientists. It’s necessary for all of us to continue to see ourselves as caring clinicians. That’s our common DNA, regardless of the ways we differentiate ourselves from one another by areas of expertise. 

What can all physicians do to become more connected to patients as persons first and patients second?

I think we physicians have done ourselves a disservice in some ways across all our different specialty groups. We have advocated so strongly for our own specialties that, at times, we have allowed the general trends in medicine to take us in directions that no specialty is happy with. 

For example, due to the burdensome nature of electronic medical records, we have all become very high-paid clerical workers. We are the highest-paid clerical workers in the hospital. That includes those of us who have a lot of direct patient contact and those who have less. We’re all spending an inordinate amount of time documenting the care processes. It’s been estimated that every one hour you spend with a patient will result in spending twice that time doing documentation. And then you will spend another hour of your personal time at night taking care of things related to that episode of care. 

This came about because we were not at the table when some of these decisions were taken up. The consequences of these implementations did not get anticipated. Or they were implemented without giving physicians sufficient agency to say, “This is a good change, but this is how it must come about so as not to sacrifice job satisfaction and meaning in our careers.” 

We’ve been hearing for years from doctors raising flags over all the time they have to spend looking at a computer screen, including when the patient is right there in the room. Do you feel these voices are still not getting heard? 

We are getting heard but for painful reasons. There has been tremendous increase in burnout among physicians. Hospital leadership and government healthcare agencies are listening now because they’re spending enormous resources to recruit physicians and get them situated only to have them leave within a couple of years due to burnout. We have good data showing that those who score high on the burnout index are likely to leave within two years.

No medical system can afford that kind of attrition. So our voices are being heard, even at the level of private payers and CMS. They recognize that to keep adding keystrokes to our already keystroke-laden lives is a terrible mistake. The pushback from physicians has been enormous. 

But our collective voice should be bigger and louder and heard earlier. It often seems we are being heard, but many people only advocate for the interests of their own particular groups. We have about 1 million physicians in the United States. If we all were to speak with one voice, our message would be pretty deafening. 

How might emerging technologies like AI change the patient-physician relationship—for better or for worse?

A lot of good work on AI in radiology has been done right here at Stanford by some of my colleagues. There’s been a lot of hype around it and a lot of fears. It’s very clear that AI offers some amazing insights into the interpretation of images. And technology doesn’t get fatigued. But we have to rid ourselves of this notion that it’s one or the other, human versus machine.

Like almost every test we order, the combination of a good test with a caring and knowledgeable physician who can help to interpret that test—who can put it in the context of the patient, the family, the society—that mix will always be necessary. AI isn’t going to replace radiologists. It will increase the precision with which we make our interpretations. And I hope it will leave more time to talk with physician colleagues as well as with patients. 

AI also isn’t going to get to know the patient’s family and understand the dynamics of their finances and their emotional states. It will make the interpretation of medical images better, but that’s about it. 

Also, AI has much potential to introduce harm. We are clearly seeing that issues of equity and inclusion can be grossly exacerbated by AI in fields outside of medicine. That’s because AI manages to do everything better, including magnify our prejudices. At RSNA I’ll be sticking very narrowly to AI in the context of radiology, but we also need to consider some of the ethical issues that we’re aware of around AI and where it’s going. 

What would you like attendees to take away from your talk? 

I hope to remind people of some of the elemental reasons that drew them to medicine. Whether they’re radiologists or technologists or administrators, most people come into healthcare because it’s about alleviating human suffering. Even if your work doesn’t directly involve patient care, you are part of this larger work. I hope people walk away with a sense of being reminded about why they’re in this line of work, about the calling. The images are after all about human beings who are suffering, to get accurate diagnoses and help them recover.

I’d like people to walk away with a reminder of what our core values are, our shared DNA. And also a reminder that medicine is a human business. Human beings are suffering. Ultimately radiology, like all medical specialties, is a profession that’s geared toward helping humans at their most vulnerable.

This is a great privilege. Not everybody gets to work in a field like medicine. Part of my role is to rouse people to focus on the preciousness of keeping the caring in patient care. 

What might you go out of your way to take in at RSNA 2019?

Actually, I’m intrigued by this conference. In my days in training, radiology training was very much about reading images. It’s about many things beside that these days. My Stanford colleague Sanjiv Gambhir, MD, PhD, will give the annual oration in diagnostic radiology. He’s going to speak on next-generation technologies and strategies for precision health. He’s doing cutting-edge stuff with molecular imaging. The whole idea of radiology as just an image-reading profession is outmoded.

I’m looking forward to hearing some of the talks and to seeing some of the exhibits. I’m especially interested in nanotechnology and in new visual ways of seeing the patient that can lead right back to the patient. There are new ways we can see pictures of our own bodies, and we can use that to psychologically better come to terms with what’s going on. Plus I always like going to conferences in fields outside my own, because I find that I learn a great deal. 

When I think back over my years as a clinician, some of the most important and significant relationships that made me a good clinician have been with radiologists. I always knew I could go to them so that I’m not getting an interpretation of an image—I’m getting another level of professional expertise. 

So I’m really excited to be speaking to radiologists. In a sense, my talk will be a tribute to all my wonderful radiology colleagues who made me a better clinician.