welcome to the show. i am susan sikora. as technology expands medical treatments, the doctors physical exam or bedside medicine take as back seat. the ease of ordering scans often chills the doctor- patient relationship. changing that is the mission of a doctor whose program at stanford university school of medicine teaches doctor to nurture the human bond with patients through more thoughtful bedside manners. his book remains on the best seller book and in the u.s. times and u.s.a. today. thank you for being here. >> thank you for having me. >> you are tackling an issue a lot of patients are aware of. you go to the doctor. they may be competent, all the t's are crossed and the i's are dotted, but you are not feeling any warm front there. >> yes. i think the image of the patient and the computer has become come innocent. the ipatient is getting wonderful care all across america, but the patient is wondering, where is everyone, when will they come talk to me and explain what is going on. that is the great paradox. we have never had better medicine. >> and you are not against technology. technology makes so much more available and the treatments are better. >> absolutely. i have no allusion that my hand is better than a ct-scan of the belly, but my hand knows where to press. i think that patients feel something establish is missing when you don't have that ritual of examining them and you don't make that kind of a connection. if you are just sitting behind a table and check off little box to order, i don't think you establish a patient relationship. >> you had a great example of one of the things i read about you before this, and that was there is a nurse -- and that is not to hit the nurse on the head because you see this all the time -- but she is reading the computer and over the shoulder, not making eye to eye contact with patient, on the scale of 1 to 10, how is your pain. >> yes. i was in a city and i have experienced that. it wasn't the nurse's fault, but it is about charting and documenting. the paper record would have looked fabulous. every t was crossed and i dotted, but as a patient i felt less focused and my rendition in the computer. that is problem. >> your resume dots the globe. you were born in ethiopia and went to medical school in india. >> yes. >> and inbetween you were where? >> i worked as an orderly inbetween medical school. i was trying to regroup after the civil war in ethiopia. i look back on that as the most valuable medical training i had -- >> as an orderly -- >> as an orderly, because i had a chance to see what happen to the patient in the time the doctor is not in the room and it gave me a healthy respect for the colleagues in nursing because that is where the care happens and you can't delegate that. >> do you think if you had been trained in an american medical facility, let's say a really terrific one, even, do you think your perspective would be the same now? would you have seen this and spot this had? >> i i can, like almost everyone who trains in the system, i think i became conceited and cynical, but information you have to digest to become a physician, makes you so focused on the disease, you lose sight of the patient. for me, my humbling experience was hiv. all of a sudden i am dealing with young men my age dying from a disease for which we have no treatment. a whole generation of us thought we could heal when you couldn't cure. you could help the family and patient come to this by your presence. that was a profound idea for me. the analogy i use with my medical students, imagine if you go home from this lecture i am giving you, and find your apartment is broken into, all your stuff is gone, and an hour later the police come by and say, here is your stuff back, but your sense of violation will linger. you won't be healed. you will probably want to move from that apartment. so, i think with patients, we get the stuff back, but we don't acknowledge the bedside manner and the resuming affects of hiv and cancer. i think it is really important. >> how receptive are the doctors to this program? >> i think i am not doing anything unique. most of us recognize this as a great need. we are driven in this direction by reimbursement and by the way health care is structured. colleagues in practice have to see 28 patients a day to pay the overhead. >> i was going to ask you about constraint on doctor's time. people go in to see a doctor and you think you will be an there have an hour and you are not. you are there a couple of minutes. you see the doctor and he or she will cult the commuter while had been consult the doctor while you are in there, write a prescription, give you some medication and that is it. >> absolutely. you have to stop everything and give them the time. a lot of doctors go into cons gentlemen of the jury practice so they can practice the type of medicine they want to practice rather than railroad the production line they don't want to be doing. >> when you say concierge, i assume there is a big price tag to that? >> you are limiting the practice, but the downside, you are not taking all patient, but those that can afford you. i think we find it is important to take care of everyone, especially those that can't afford us. i think there is a special privilege in medicine. >> you say modern training takes lovely people and converts them into bottom line, somewhat cynical, diseased, oriented people. >> most of us, i think the good news is, come back to a version of ourself. some times it take as few year, personal illness, maturity or age. but you can't distill it in a bottle and teach it to the students, they have to come to it through phases of their profession. >> right. we will take a break. when we come back, we will ask the doctor, i wonder if we expect too much of doctor or so maybe the profession itself does. should we more demanding of the warmth factor when somebody is applying to be a medical student when, we return. when i joined the california national guard, i never thought i'd be saving lives. it's more than money for college. it's built my character and given me a sense of accomplishment. the guard opened the door for me. now i'm on a career path, and i'm the leader of my team. i put on the uniform and have a whole new outlook on life. country, community, family-- that's what matters most to me. if that's what matters to you, go to 1-800-go-guard.com. my guest is the professor and senior associate prayer for the practice of medicine at the stanford university school of medicine. he is the writer of great novels, cutting for stone is your latest one? >> yes. it is a medical epic. i see medicine as a promanhattannic and passionate pursuit. i wanted to put everything i love about medicine in the novel. everything exhumed the grandeur of medicine. >> it begin with a no one giving birth to twins in -- nuns giving birth in the operating room. >> you talk about the bedside manner that has been lost. years ago when i was a little girl, the doctor would do a physical exam and they would make house calls years ago. none of that happens these days. here is my question. with younger doctors coming in, being raised on computers, who have never known a life without a computer screen near them, in their own homes, are they on board, i am good, great doctor, good at math and science, accurate and cure, what do i have to be if best for? >> i think kids come into medical school now and before, they come in with all the right qualities. often because of a personal experience or loss in their family. they come in full of compassion or the great capacity to imagine the suffer of course patients. something happens when they go to preclinical to clinical years, or as i call it, precynical to cynical years. it is hard. focusing on the disease makes them think of the heart attack in bed 3. it is hard. the good news is i think they come back to some version of themselves. their facility with computers makes it easier for them both to relate with testing than it does for me. i cannot do it. i will have my intersection, then the computer work. >> you said i pick up the hand before i take the pen. >> high touch before the high- tech, you know? >> absolutely. if you think about it, one individual is coming to another, telling them things they won't tell their priest or rabbi, then incredibly they disrobe and allow touch, which in any other context is assault. tell me this is not a ritual which we need to bring our best to. it seem to be quite clear that patient from any culture expect ritual. they arrive and are ready to be examine and the physician does this cursory sticking the stethoscope on top of the dressing gown. they have a sense they have not been dealt with properly. i think the physical is an important ritual. it is he meants the bond and a way of -- crew meants the bond and it -- korea meants the monday -- cements the bond. >> do you think doctor haves to be the smartest and put in long hours. you hear about their horrible schedules, are sleep deprived and still have to keep going. we expect doctor to be gods, cure us and do all this stuff. then we are shocked when a doctor getting sick. you say, what,'s doctor. that shouldn't happen to him or her. >> when you have a serious illness, it is almost a team. yet the family and patient need one person to be the quarterback. i think the challenge for us in medicine is we have to find a way to deliver complex care with many different people, but have one person be the liaison, the person to keep the communication going. it doesn't work when 16 people are coming to room and each one has a little piece to say. someone need to coalesce this. it is a the primary care physicians that expect that is being so poorly reimbursed, you wouldn't want to be in primary care the way things are going right now. the students have great hearts but end up being in radiology, or though pee ticks, and an ceasology, and what not. that is where the rewards are good. taking care of the elderly. your mother or mine need as good 45 minutes to have all their questions, problems and medications resolved. we pay for that less than we pay for someone to stick a needle in you for something they may or may not need. >> >> i have a doctor for my mother who is caring when he is with her. he is a sensitivity she is 86 and needs to be heard when she says something. he has a sense of humor and spends time with her but i guess everybody is not that lucky. how do you find a really good doctor? >> i think by asking around word of mouth. if you can afford to pay a concierge service, $3,000 or $5,000 a year, it is not a bad thing. you pay so much in co-pays if you are ill, this is not a big expense. you will get attention, time and responsiveness with home visits, too. i hate to say this, but it also means the great majority of people that can't afford that are relegated to the practices that have to turn them over. we do badly need health care reform and a way to deliver uniformly good care and reimburse the things that matter to anaglyph this program at stan -- matter to you and i. >> you have this program in stanford. is it anywhere else in california? >> well, i think all of us are struggle with to teach kid to embrace technology and the good old-fashioned skills of examining the body. how embarrassing to miss a limp node or tumor that was visible, palpable and only viewed to you when you send the x-ray for something else and they only had five doctor's visits for something else. that is my nightmare. a patient will come through my hands with a treatable, diagnoseable condition that i missed because of sloppy treatment. so, i want to have people get to the place of saying you can be a high class place like stanford and still embrace these issues. >> i wish you good success with this. i think it is badly needed and i think every patient who has been out there with a doctor would say yes, you see the need for this. your website is abrahamvergese.com. the book is called cutting for stone. if you are looking for beach reading, it will get warmer very soon. thank you for being here. >> thank you. >> stay with us. more ahead. welcome back. kids here in the bay area have little, if any, one-on-one time with a parent. big brothers and sisters try to fill that cap, matching caring and mentoring volunteer to kids in need. but who can be a big brother or sister. we have marcia hodges, big brother and sisters ceo in the area and patrick, a big brother. thank you for being here. let's talk about the kids here. some people think they are or fans, or -- orphans or foster kids? who are they? >> every kid has an adult in their life that cares enough to call us and say they want a big brother or sister for their child. they may be working three jobs and don't have the kind of time and these kids are coming from high risk, at-risk communities who really needs somebody who expose to what else is going on outside their little neighborhood. >> do you think it is hard for a parent to call and ask for that kind of help. is it almost and add mission of saying i can't do the parenting -- almost and add mission of saying i can't do the parenting by myself? >> north carolina i think parent -- no. i think it is good that parents realize they can't do it all themselves. it is a great resource. we ask them to see them a few times a year. don't do the big fancy things like amusement parks. take them to the grocery store, to wash the car, throw the frisbee, walk the dog, incorporate them into your life. sit time we are looking for. >> how much time, two or three times a month, but how much time per visit? >> it might be one hour or three or four hours. it depends on what is available in terms of the volunteer's time right now. but the primary thing that is most important is to be consistent. if you say you are going to be there, make sure you are there. >> the last thing they need is to promise something and not deliver. patrick, how did you get involved? >> i started mentoring in the bay area and i thought, how can i help out in the community. when you speak of children, you say let's help the less fortunate, i thought, how can i take action, especially in the black community. there are tons of kids that are black or latino who need help but there was no one stepping up. this was my chance to take action and step forward. >> do you think you wonder how good you would be? maybe people say i don't know how to talk to a kid. >> my first kid who was in a foster home when i met him, he was 15 and it was hard to relate. a teenager. >> a teenager. although you are young. >> still, it was stuff. luckily the program allowed me great support, support specialists who helped me out and said okay, here is what you can do with them. give me workshops and help me get through to them to relate. >> what are some of the things you tell people or you experienced or were told to do to break the initial ice. because this kid is coming in and he knows maybe the kid is not even on board with this. maybe this is something the mom said would be a good idea. >> they have to. >> the kid that is to been on board? >> yes. the kid has to also want it. they might be hesitant, kind of put up a attitude about it, but if they said they want it, they will give it a try and that is all that matters. >> what do you do about the first initial awkward moments. >> one of the first things is to be authentic b open and ask questions, just to get to know them a little better. be consistent, because if you are constantly coming, they see you care. i know one time i went to a museum with the my foster child. he didn't seem he was into it, but when he got home he told his mother all about it and was excited about it. be consistent and authentic. >> maybe he will not chitchat about it when he is doing it, but he goes home and he is excited about it. >> absolutely. >> so, you are not a parent. >> >> no. i am not. >> but maybe if you are a parent, you have enough with your own kids. but if you have never had a child, maybe you might worry you don't have experience with kids. >> be authentic. we have a full-time staff and their jobs is to help provide support to the volunteers and stay in touch with the parent, the child and the volunteer, to make sure there is good communication -- because as you said that, initial interaction is kind of like a blind date. they are meeting each other for the first time and they are supposed to see each other for a year, but that is really where our staff helped make sure the match lasted for a long time. they may ask for a one year commitment, but it ends up being an average of 2.5 year, so it is a long time. >> i think in this day and age, people want to make sure the little one they are handing their little one or teenager over to is safe, reputable. how well do you check out someone like a patrick. >> it is a thorough screening process, because they are one- on-one in and out the community. our number one priority is safety for the children. fortunately we have staff who are very well trained on how to do that. >> how are the results of the program? if you could take the kid who goes through the program, versus i don't know if there is a way to check the kids that don't. but the at-risk kids that don't have time, attention and get in trouble because they are idle and board and hang out with the wrong -- bored and hang out with the wrong kids. >> yes. there are studies that show kids that stay in school, become less truant, and keep from using drugs and getting involved with gangs. those are statistics that have been proven in clinical studies. >> finally you have a big event coming up on april 7th at that time palace hotel honoring extraordinary matches. is this a fundraiser for you? >> it is. we have over 400 people that will be there on april 7th. >> we are showing you the information on the screen right now. april 7th at 5:30? >> yes. the palace hotel. tickets are $250 each. it is a fundraiser. we really need people to realize that not only do we need volunteers, but we need money to make sure the kids are safe and have long relationships. >> and you are honoring patrick? >> yes. >> enyou will be there with your child? >> yes. >> it is well deserved and it is great people like you show up. i love the fact you said you are knew to the -- new to the area and looked around right away for something to do. most people wait a long time. thank you for being here and continued success with your work with the community. we will leave you now with the alvin alley dance theater. i am susan sikora. thank you for watching.