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“Cutting for Simple” and the Importance of True Presence

by Jonathan Bush, President & CEO

You’ll never guess who’s coming to Boston to be the keynote speaker of our 2012 User Conference.

Give up?

Try Dr. Abraham Verghese, author of my all-time favorite book, “Cutting for Stone.”

We couldn’t be more honored.

Just as last year’s keynote, Dr. Atul Gawande, best tells the story of what we have today and what we what we want to have across our health care system, Dr. Verghese speaks better than anyone of what we have and what we want inside the most intimate core of that system—the consult. Whether in the exam room, at the bedside, or over email, there is a certain sanctity to that central moment of health care. We all wish to preserve and serve that sanctity…but it seems to be deteriorating.

Here’s what Dr. Verghese told us in a recent interview:

One of my heroes is a physician who trained at Harvard and came from a small community in Laredo, Texas. He trained at Harvard and went back to Laredo and practices now, even in his 80s. And he has this ability to walk into a room and sit on the patient's bed and create the illusion that he has all kinds of time and nowhere else he needs to be. And paradoxically by being so completely in the moment he manages to spend less time with patients than many of us who are hurrying to get on to the next thing.

Now, take the fiction version.

In “Cutting for Stone,” Dr. Verghese shares a fictional tale of doctors for whom there are no insurance companies, malpractice attorneys or auditors from the Office of the Inspector General. They have only their tools, training and each other. The presence of mind and the depth of connection to their patients that emerges from this book affected me deeply. Dr. Stone is a character who is muddled as a human, but when confronted face-to-face with a truly ill patient, he awakens to a clarity and brilliance that resonates with everything we all want medicine to be.

Years ago, when I was driving an ambulance in New Orleans, I occasionally had to treat a patient when hospitals were on “override” or too far away, but the patient was truly in medical trouble. As a result I was honored with an unfettered one-to-one bond. My tools, presence of mind, good will—and my paramedic partner—were everything that was available to the patient…and the patients took the “medicine.” The connection of that bond yielded a feeling—an adrenaline-infused feeling and true presence—that I have never, ever since felt.

At athenahealth, our strongest wish is to root out the plaque that has occluded this connection between doctor and patient. Society wants doctors to manage populations over stretches of time, not individual instances at a specific “exam room moment.” But in order to achieve the story Gawande describes without losing sight of the story Verghese tells, a new player is needed in the system.

The new player must be one the doctor can trust:

  • To follow-up on everything that gets decided in that beautiful exam room moment and makes sure it happens
  • To survey populations to help doctors decide which patients next require their pure, undivided attention
  • To scrape and shove the Greek chorus of insurance payers and government and tort trawlers OUT of the moment and feed them what they need out in the hallway
  • To leave behind an electronic chart that doctor, patient, and consulting colleagues can actually use together to be in the present and to be human in the face of illness

When I think of all those “CCHIT–compliant templates” and imagine those thousands of doctors clicking away to please their Greek choruses—and thus totally confuse any patient or colleague that they might need to share information with—I go berserk.

I’m so done with that.

This past year, we did the hardest part of the work to break free of this. We have learned all the rules and we have developed the ability to codify everything that comes at our clients, even paper. Now we need a more beautiful way of showing them what they need.

It will be something that we hope Dr. Verghese can be proud of…and even Dr. Stone as well.

Next up, stay tuned for a few extraordinary blog posts from Dr. Verghese himself….

Jonathan Bush is the President and CEO of athenahealth.

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