On his first day as an attending physician at Stanford, Abraham Verghese, MD, noticed something unusual. “I was struck by the fact that the house staff were spending a great deal of time wedded to their computers,” he recalled. “And it was not their doing. They didn’t sign on to do that.”
His experience reflects an increasingly common trend in modern medicine: With the introduction of new medical technologies, physicians today find themselves spending more time at the monitor and less time at the bedside.
Verghese recounted his story to a packed room of physicians and clinical educators who had traveled to Stanford from places as far flung as Brazil and Australia to attend the inaugural Stanford Medicine 25 Symposium.
The two-day event provided attendees with the tools to foster and encourage a robust bedside medicine culture at their home institutions.
The time is right, said Verghese. Today, many physicians and educators are advocating for a more hands-on approach to medicine. At the same time, an increasing number of bedside medicine programs are popping up at universities and hospitals worldwide: “I’m hoping that this is the moment when we all come together, and we stay together and connected in this effort to take what we all believe are fundamental and important skills - important to the welfare of the patient, important to practice cost-effective medicine, important in choosing wisely – and we form a community with solidarity around that theme.”
Throughout the symposium, participants learned the basics of evidence-based physical diagnosis from Steve McGee, MD, author of a textbook of the same name and a professor of medicine at the University of Washington. They learned how to schedule and program consistent teaching rounds, and how to incorporate technology without losing connection with the patient. They also heard from Andrew Elder, MD, professor of medicine at Edinburgh University and Junaid Zaman, MD, a postdoctoral researcher at Imperial College London and Stanford, about the MRCP PACES examination – a high stakes clinical exam that all medical school graduates in the UK must pass to continue their postgraduate education, an exam run and administered by Elder.
During an afternoon panel, experts from Johns Hopkins, Stanford, the Seattle VA, and the University of Alabama, Birmingham discussed ways to create a bedside medicine culture. Ideas included inviting master clinicians to teach at the bedside and hosting regular workshops. But, the panelists agreed, the support of community is critical. “It’s really hard to build a bedside medicine experience,” noted Brian Garibaldi, MD, of Johns Hopkins. “Community is key.”
In a series of breakout sessions, participants had the opportunity to practice exam techniques and to work together to develop their own 5 Minute Bedside Moment - a teaching vignette that includes both a narrative and a physical maneuver.
After an hour of brainstorming, they took to the stage with their stethoscopes and reflex hammers in hand. Presentations varied widely, from the gait assessment of elderly patients to pediatric oral examinations. One group chose to tackle opiate toxicity in hospice patients, and they also demonstrated ways to compassionately support grief-stricken family members. The audience gave each presentation their rapt attention, nodding their heads in agreement and recognition, laughing when a seasoned physician played the role of an unsure medical student, knitting their brows in concern, and furiously taking notes.
For many attendees, the symposium was a unique chance to interact and collaborate with like-minded professionals. “This meeting was a great model of what all of us should be doing,” said Ruth Berggrenn, MD, the director of the Center for Medical Humanities & Ethics at the University of Texas, San Antonio. “We should go back to our institutions, engage others, and train more facilitators. And we should have a sense of pride and belonging in this movement.”
This feeling of connection and community lingered long after symposium co-director John Kugler, MD, offered his closing remarks. During the final reception, participants exchanged cards, contact information, and ideas about future collaborations. “You should give rounds at our institution,” one physician suggested to a new acquaintance. “I bet our residents would love to hear about the work you’re doing.”
Lindsey Baker is the communications manager for Stanford’s Department of Medicine.
Previously: Stanford Medicine 25 Skills Symposium to focus on building leaders for the bedside medicine movement, A call for extended bedside manner training and Abraham Verghese discusses reconnecting to the-patient at the bedside
Photo of symposium attendees by Norbert von der Groeben