Abraham Verghese, MD, MACP

All Publications

• My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS Simon & Schuster, New York, NY 1994. Verghese A
• The Tennis Partner: A Doctor's Story of Friendship and Loss 1998 Aug. (Harper Collins in the USA, Vintage in the UK, Penguin in India). 1999 Oct Paperback version (by Harper Perennial in the USA and Vintage in UK) Verghese A
• The Importance Of Being. Health affairs Verghese, A. 2016; 35 (10): 1924-1927

  Abstract

  Good patient care is found not on a computer screen but in being truly present with patients.

  View details for PubMedID 27702966

• Evolutionary Pressures on the Electronic Health Record: Caring for Complexity. JAMA Zulman, D. M., Shah, N. H., Verghese, A. 2016; 316 (9): 923-924

  View details for DOI 10.1001/jama.2016.9538

  View details for PubMedID 27532804

• The Five-Minute Moment. American journal of medicine Chi, J., Artandi, M., Kugler, J., Ozdalga, E., Hosamani, P., Koehler, E., Osterberg, L., Zaman, J., Thadaney, S., Elder, A., Verghese, A. 2016; 129 (8): 792-795

  Abstract

  In today's hospital and clinic environment, the obstacles to bedside teaching both for faculty and trainees are considerable. As Electronic Health Records (EHR) systems become increasingly prevalent, trainees are spending more time performing patient care tasks from computer workstations, limiting opportunities to learn at the bedside. Physical examination skills are rarely emphasized and low confidence levels, especially in junior faculty, pose additional barriers to teaching the bedside exam.

  View details for DOI 10.1016/j.amjmed.2016.02.020

  View details for PubMedID 26972793

• Inadequacies of Physical Examination as a Cause of Medical Errors and Adverse Events: A Collection of Vignettes. American journal of medicine Verghese, A., Charlton, B., Kassirer, J. P., Ramsey, M., Ioannidis, J. P. 2015; 128 (12): 1322-1324 e3

  Abstract

  Oversights in the physical examination are a type of medical error not easily studied by chart review. They may be a major contributor to missed or delayed diagnosis, unnecessary exposure to contrast and radiation, incorrect treatment, and other adverse consequences. Our purpose was to collect vignettes of physical examination oversights and to capture the diversity of their characteristics and consequences.A cross-sectional study using an 11-question qualitative survey for physicians was distributed electronically, with data collected from February to June of 2011. The participants were all physicians responding to e-mail or social media invitations to complete the survey. There were no limitations on geography, specialty, or practice setting.Of the 208 reported vignettes that met inclusion criteria, the oversight was caused by a failure to perform the physical examination in 63%; 14% reported that the correct physical examination sign was elicited but misinterpreted, whereas 11% reported that the relevant sign was missed or not sought. Consequence of the physical examination inadequacy included missed or delayed diagnosis in 76% of cases, incorrect diagnosis in 27%, unnecessary treatment in 18%, no or delayed treatment in 42%, unnecessary diagnostic cost in 25%, unnecessary exposure to radiation or contrast in 17%, and complications caused by treatments in 4%. The mode of the number of physicians missing the finding was 2, but many oversights were missed by many physicians. Most oversights took up to 5 days to identify, but 66 took longer. Special attention and skill in examining the skin and its appendages, as well as the abdomen, groin, and genitourinary area could reduce the reported oversights by half.Physical examination inadequacies are a preventable source of medical error, and adverse events are caused mostly by failure to perform the relevant examination.

  View details for DOI 10.1016/j.amjmed.2015.06.004

  View details for PubMedID 26144103

• The Bedside Evaluation: Ritual and Reason ANNALS OF INTERNAL MEDICINE Verghese, A., Brady, E., Kapur, C. C., Horwitz, R. I. 2011; 155 (8): 550-U125

  Abstract

  The bedside evaluation, consisting of the history and physical examination, was once the primary means of diagnosis and clinical monitoring. The recent explosion of imaging and laboratory testing has inverted the diagnostic paradigm. Physicians often bypass the bedside evaluation for immediate testing and therefore encounter an image of the patient before seeing the patient in the flesh. In addition to risking delayed or missed diagnosis of readily recognizable disease, physicians who forgo or circumvent the bedside evaluation risk the loss of an important ritual that can enhance the physician-patient relationship. Patients expect that some form of bedside evaluation will take place when they visit a physician. When physicians complete this evaluation in an expert manner, it can have a salutary effect. If done poorly or not at all, in contrast, it can undermine the physician-patient relationship. Studies suggest that the context, locale, and quality of the bedside evaluation are associated with neurobiological changes in the patient. Recognizing the importance of the bedside evaluation as a healing ritual and a powerful diagnostic tool when paired with judicious use of technology could be a stimulus for the recovery of an ebbing skill set among physicians.

  View details for DOI 10.1059/0003-4819-155-8-201110180-00013

  View details for Web of Science ID 000296066300022

  View details for PubMedID 22007047

• Cutting for Stone A novel published by Alfred P. Knopf, NY Verghese A 2009
• Learning bedside medicine. The virtual mentor : VM Kugler, J., Verghese, A. 2009; 11 (11): 900-903

  View details for DOI 10.1001/virtualmentor.2009.11.11.mnar1-0911

  View details for PubMedID 23207007

• The Calling New England Journal of Medicine Verghese A 2005; 352 (18): 1844-7
• Making mindset matter. BMJ (Clinical research ed.) Crum, A. J., Leibowitz, K. A., Verghese, A. 2017; 356: j674-?

  View details for DOI 10.1136/bmj.j674

  View details for PubMedID 28202443

• Annals for Hospitalists Inpatient Notes - Rituals in Chaos, the Sacred in the Profane. Annals of internal medicine Hosamani, P., Verghese, A. 2017; 166 (2): HO2-?

  View details for DOI 10.7326/M16-2737

  View details for PubMedID 28114474

• The Value of Physical Examination: A New Conceptual Framework SOUTHERN MEDICAL JOURNAL Zaman, J., Verghese, A., Elder, A. 2016; 109 (12): 754-757

  Abstract

  The physical examination defines medical practice, yet its role is being questioned increasingly, with statistical comparisons of diagnostic accuracy often the sole metric used against newer technologies. We set out to highlight seven ways in which the physical examination has value beyond diagnostic accuracy to reaffirm its place in the core skills of a physician and guide future research, teaching, and curriculum design. We show that this more comprehensive approach to the physical examination of its "utility" beyond that of reaching a diagnosis can be beneficial to both doctor and patient.

  View details for DOI 10.14423/SMJ.0000000000000573

  View details for Web of Science ID 000389799300007

  View details for PubMedID 27911967

• Accreditation Council for Graduate Medical Education (ACGME) Milestones-Time for a Revolt? JAMA internal medicine Witteles, R. M., Verghese, A. 2016; 176 (11): 1599-1600

  View details for DOI 10.1001/jamainternmed.2016.5552

  View details for PubMedID 27668812

• I Carry Your Heart. JAMA cardiology Verghese, A. 2016; 1 (2): 213-215

  View details for DOI 10.1001/jamacardio.2015.0353

  View details for PubMedID 27437895

• How valuable is physical examination of the cardiovascular system? BMJ (Clinical research ed.) Elder, A., Japp, A., Verghese, A. 2016; 354: i3309-?

  Abstract

  Physical examination of the cardiovascular system is central to contemporary teaching and practice in clinical medicine. Evidence about its value focuses on its diagnostic accuracy and varies widely in methodological quality and statistical power. This makes collation, analysis, and understanding of results difficult and limits their application to daily clinical practice. Specific factors affecting interpretation and clinical application include poor standardisation of observers' technique and training, the study of single signs rather than multiple signs or signs in combination with symptoms, and the tendency to compare physical examination directly with technological aids to diagnosis rather than explore diagnostic strategies that combine both. Other potential aspects of the value of physical examination, such as cost effectiveness or patients' perceptions, are poorly studied. This review summarises the evidence for the clinical value of physical examination of the cardiovascular system. The best was judged to relate to the detection and evaluation of valvular heart disease, the diagnosis and treatment of heart failure, the jugular venous pulse in the assessment of central venous pressure, and the detection of atrial fibrillation, peripheral arterial disease, impaired perfusion, and aortic and carotid disease. Although technological aids to diagnosis are likely to become even more widely available at the point of care, the evidence suggests that further research into the value of physical examination of the cardiovascular system is needed, particularly in low resource settings and as a potential means of limiting inappropriate overuse of technological aids to diagnosis.

  View details for DOI 10.1136/bmj.i3309

  View details for PubMedID 27598000

• Clinical education and the electronic health record: the flipped patient. JAMA Chi, J., Verghese, A. 2014; 312 (22): 2331-2332

  View details for DOI 10.1001/jama.2014.12820

  View details for PubMedID 25490318

• A piece of my mind. The road back to the bedside. JAMA-the journal of the American Medical Association Elder, A., Chi, J., Ozdalga, E., Kugler, J., Verghese, A. 2013; 310 (8): 799-800

  View details for DOI 10.1001/jama.2013.227195

  View details for PubMedID 23982364

• The Attending Physician on the Wards Finding a New Homeostasis JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Wachter, R. M., Verghese, A. 2012; 308 (10): 977-978

  View details for Web of Science ID 000308579300017

  View details for PubMedID 22968883

• Internal Medicine Residency Redesign: Proposal of the Internal Medicine Working Group AMERICAN JOURNAL OF MEDICINE Horwitz, R. I., Kassirer, J. P., Holmboe, E. S., Humphrey, H. J., Verghese, A., Croft, C., Kwok, M., Loscalzo, J. 2011; 124 (9): 806-812

  Abstract

  Concerned with the quality of internal medicine training, many leaders in the field assembled to assess the state of the residency, evaluate the decline in interest in the specialty, and create a framework for invigorating the discipline. Although many external factors are responsible, we also found ourselves culpable: allowing senior role models to opt out of important training activities, ignoring a progressive atrophy of bedside skills, and focusing on lock-step curricula, lectures, and compiled diagnostic and therapeutic strategies. The group affirmed its commitment to a vision of internal medicine rooted in science and learned with mentors at the bedside. Key factors for new emphasis include patient-centered small group teaching, greater incorporation of clinical epidemiology and health services research, and better schedule control for trainees. Because previous proposals were weakened by lack of evidence, we propose to organize the Cooperative Educational Studies Group, a pool of training programs that will collect a common data set describing their programs, design interventions to be tested rigorously in multi-methodological approaches, and at the same time produce knowledge about high-quality practice.

  View details for DOI 10.1016/j.amjmed.2011.03.007

  View details for Web of Science ID 000294043100019

  View details for PubMedID 21854887

• The Physical Exam and Other Forms of Fiction J Gen Intern Med Kugler J, Verghese A 2010
• Cutting for Stone A novel published by Vintage Books Edition, NY Verghese A 2010
• Caring for Ivan Ilyich J Gen Intern Med Charlton B, Verghese A 2010; 25 (1): 93-5
• In Praise of the Physical Examination British Medical Journal Verghese A, Horwitz RI 2009; 339: 5448
• A touch of sense "Health Affairs Verghese A 2009; 24 (8): 1177-82
• Culture Shock: The Patient as Icon, Icon as Patient New England Journal of Medicine Verghese A 2008; 359 (26): 2748-51