The Doctor Is Present

It’s a common complaint from contemporary patients: “During routine visits to my doctors, they never make eye contact with me. Their fingers are always on their laptop keys, and their eyes are glued to the computer. It feels like we aren’t in the same room.”

Health care providers feel this disconnect, too, as they find themselves in front of glowing screens rather than at the bedside; it is a situation that contributes to high rates of burnout.

It is also a subject of great interest to Abraham Verghese, MD, whose recent National Humanities Medal citation reads in part: “To Abraham Verghese, for reminding us that the patient is the center of the medical enterprise.” What’s often missing from today’s patient-physician relationship, says Verghese, is presence, and it has become the name — as well as the driving force behind — a new Stanford center called Presence: The Art and Science of Human Connection. Presence looks to foster research, dialogue and collaboration across the Stanford campus to bring about measureable improvement in the medical experience for patients and physicians. A particular focus will be medical error.

There’s a lot to learn, Verghese says — and maybe a few things to unlearn. That’s where collaboration comes in. The center will work with Stanford’s seven schools to discover novel ways to champion humanism in modern medicine. Executive Director Sonoo Thadaney, MBA, described several current projects: “We’ve partnered with the Stanford Center for the Advanced Study in the Behavioral Sciences to support one fellow, and with the Graduate School of Business to create the Innovative Health Care Leaders Program. Presence is also incubating a new global Society of Bedside Medicine, under the joint leadership of Stanford, Johns Hopkins, University of Alabama, University of Edinburgh and others.”

The idea for Presence began when Verghese realized two unique things about Stanford. First, all the schools share the same campus. Second, says Verghese, “We have access to an interdisciplinary kind of research that I suspect would elude other places because they don’t quite have that opportunity.”

Sensing that Stanford could leverage these interdisciplinary connections into tangible projects that could improve the patient-physician experience, Verghese presented that idea to Dean Lloyd Minor because he thought it matched Minor’s notion of precision health. “If we’re committed to precision health,” he explains, “then to me it implies we need precision at the level of the cell and the molecule; at the population level; and in the understanding of the human experience of health and wellness.”

Verghese and Thadaney recently discussed their vision for the use of technology in medicine in less obtrusive ways. Verghese spoke of “harnessing the technology for the human experience, which means having the electronic medical record, for example, understand our ritual and serve us. Currently, our rituals are disrupted as we struggle to accommodate the computerization of what was a very heavy ritual-dependent field.”

Thadaney concurred, adding, “One of the things we talk about is that any human experience — whether it’s between a patient and physician or anyone else — is an analog experience. And by attempting digitization of it, we over-simplify it and weaken the crucial narrative. We’re looking to harness existing and future technologies to enhance the human experience in medicine to be more human-centric.”

While it is early to speak about legacy, Verghese finished with some hopes for the future of Presence: “I’m hoping that some years from now we might have made a particular impact on a certain kind of medical error. Perhaps we identify a critical element to be cognizant of in a particular story, or we develop a signature checklist of high-yield things to look for in the setting of a particular symptom. Or it might be that what transpires in a clinic in 2026 will be shaped by work done with our colleagues in psychology or business or anthropology.”