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To “Live in the Moment” of Patient Care

by Abraham Verghese, MD, MACP

If you haven’t read the novel “Cutting for Stone” yet, you might want to put this New York Times bestseller on your list. Written by physician, Stanford professor and author Dr. Abraham Verghese, it tells the story of orphaned “twin brothers Marion and Shiva Stone born of a tragic union between a beautiful Indian nun and a brash British surgeon at a mission hospital in Addis Ababa” and Marion’s later arrival as a physician at “an underfunded, overcrowded New York City hospital…”

As CEO Jonathan Bush recently wrote, the book conveys the importance of presence between physician and patient in the exam room. This is a topic our clients know well—please see the recent comment on Jonathan’s post from Dr. Lanna McClain of Burleson, Texas—and a critical human interaction we try to preserve in our work on behalf of physicians.

We are honored to have Dr. Verghese deliver the keynote address at the athenahealth 2012 User Conference in April. In the meantime, he was good enough to share some thoughts on modern medicine in a recent telephone interview.

In talking to physicians, we find that so many of them are overwhelmed. Because of the many demands thrust upon them, they often can't focus on care as they would like to. Besides choosing the right technology and using it well, what can doctors do about this?

I think I'm in exactly the same position as the doctors that you're describing. I think we're all challenged by time constraints, by urgent but not important things that pop up and important things that are not urgent that get overlooked for that reason.

I think that I'm always struck by the fact that there's always one moment in the day where your entire attention is required and you're required to forget about what's coming or what's gone past. Sometimes you need to recognize that moment, that one patient who really requires you to change your schedule, requires you to push everything back or change things around. You can't necessarily do that for every patient every moment of every day and not everybody needs it. But recognizing that one moment when it is needed and being available I think is the key.

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.

To me I think the most important thing we can do for ourselves is to live in the moment or as William Osler once said, "To live each day in day-tight compartments."

This came to Osler because he was on an ocean voyage coming back to America from England to deliver a commencement speech. When he was walking on the deck of this giant ship, he heard the sound of big metal doors clanging shut. And he asked the captain what that was and the captain said after the Titanic they had designed ships now so that they had individual watertight compartments so that if something hit the ship it wouldn't flood the whole ship, it would just flood one compartment.

Osler was so impressed by that. And he connected that episode with a very famous saying of the Scottish historian and critic Thomas Carlyle, who once advised “not to see what lies dimly in the distance but to do what clearly lies at hand.”

Osler melded the two and talked about how physicians should live each day in 'day-tight compartments.' And I think that many of us in medicine too often are with our heads partly in what is to come and our heads partly in what's gone before when really what our patients require is us to be fully present in the moment. It's less about time than about the quality of your presence. Recognize that one moment where you need to give both the quality and the time to that one patient.

Stay tuned next week for a 2nd installment from Dr. Verghese. And in the meantime, you can learn about and register for our upcoming User Conference, starting April 1, here in Boston.

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