HIV and ID Observations

Many HIV/ID specialists first heard of Abraham Verghese from his book My Own Country: A Doctor’s Story, which was published in 1994.  He told us what it was like to be a newly-minted ID doctor, thrust into treating the first cases of HIV/AIDS in a remote town in Tennessee during the mid-1980s.

Compelling stuff — I thought the book was terrific.  (And apparently I’m not alone, as I’ve received it as a gift no fewer than 3 times.)

In this week’s New England Journal of Medicine, Verghese has a wonderful perspective piece on a phenomenon that will be all-too familiar for doctors working in academic medical centers:

On my first day as an attending physician in a new hospital, I found my house staff and students in the team room, a snug bunker filled with glowing monitors. Instead of sitting down to hear about the patients, I suggested we head out to see them. My team came willingly, though they probably felt that everything I would need to get up to speed on our patients — the necessary images, the laboratory results — was right there in the team room. From my perspective, the most crucial element wasn’t. 

What follows is a beautiful description of the tension between the “traditional” ways of clinical medicine — which involve taking real histories and doing actual physical exams — and the new way, which uses in place of the real patient “an entity clothed in binary garments: the iPatient.”  And what’s wrong with treating the iPatient?

Pedagogically, what is tragic about tending to the iPatient is that it can’t begin to compare with the joy, excitement, intellectual pleasure, pride, disappointment, and lessons in humility that trainees might experience by learning from the real patient’s body examined at the bedside. When residents don’t witness the bedside-sleuth aspect of our discipline — its underlying romance and passion — they may come to view internal medicine as a trade practiced before a computer screen.

Even if you don’t believe in his premise — that something is lost when “the iPatient’s blood counts and emanations are tracked and trended like a Dow Jones Index” — this is a nifty bit of medical writing.  You’ll find here none of the sanctimony such pieces often have (“in my day, we spun our own hematocrits, and were the better for it …”), just common sense about the potential consequences of focusing more on the computer screen than the person being treated.

Highly recommended.