Podcast Summary: People I (Mostly) Admire – Abraham Verghese Thinks Medicine Can Do Better (Update)

Podcast: People I (Mostly) Admire
Host: Steve Levitt (Freakonomics Radio Network)
Guest: Abraham Verghese (Physician, Professor at Stanford, Bestselling Novelist)
Air Date: May 3, 2025

Main Theme Overview

This episode revisits a rich, candid conversation between Steve Levitt and Abraham Verghese about his extraordinary dual career as a Stanford physician and bestselling author. The focus is on Verghese’s remarkable personal journey—from Ethiopia to America—as well as his nuanced perspectives on compassionate medicine, the transformation of healthcare, the AIDS crisis, and storytelling’s enduring power to heal. The episode explores the deep need for more humanism in medicine and the personal costs and unexpected rewards that come with bucking the trend toward depersonalized care.

Key Discussion Points and Insights

1. Early Life and Faith

Timestamps: 02:27 – 08:24

• Ethiopian Upbringing, Indian Roots
  • Verghese was born in Ethiopia to Indian Christian parents, part of an ancient Christian community tracing roots to St. Thomas the Apostle (02:27).
  • He describes how the Emperor of Ethiopia recruited teachers from his parents’ community, strengthening cross-cultural religious ties (03:39).

“Our religion is very much like Orthodox Armenian or Greek, and yet it has little traces of Hindu customs … I became aware early on that we were part of this community...”
—Abraham Verghese, 02:27

• Impact of Political Upheaval

  • The Ethiopian revolution (the Derg era) disrupted his family and career path. He was forced to leave medical school and become an immigrant in the U.S. (04:53).
  • Started working as a hospital orderly, which became unexpectedly formative:

    “I really saw what happens to patients in the 23 hours and 57 minutes that doctors are not in the room … and gave me a real solidarity with the nursing profession.”
    —Abraham Verghese, 05:15

• Adapting to New Status and Culture

  • Going from medical student prestige to low-status jobs was both humiliating and eye-opening (06:27).
  • Despite the setback, he witnessed shocking realities in elderly care and the lives of support staff, and grew to appreciate blue-collar camaraderie (08:45).

2. Path Back to Medicine and Lessons Learned

Timestamps: 10:32 – 11:29

• A serendipitous encounter with a medical textbook reignited his passion for medicine.

• Family support enabled him to re-enter medical studies in India, returning with increased dedication:

  “I knew how much I loved this and I gave it my all.”
  —Abraham Verghese, 10:32

• Advocating for Gap Years

  • Both Levitt and Verghese argue that working outside academia before advancing in one’s field builds empathy, gratitude, and perspective (11:13).

3. Frontlines of the AIDS Crisis

Timestamps: 13:49 – 21:50

• Expectation vs. Reality in Infectious Disease

  • Verghese chose infectious diseases for its curative potential but found himself treating AIDS at its most hopeless stage in rural Tennessee (14:36).
  • He writes that AIDS taught him the crucial distinction between curing and healing.

• Stigma, Rejection, and Empathy

  • Describes the double harm endured by early AIDS patients—shunned both by society and many in medicine:

    “...the metaphor of HIV was one of shame and one of secrecy ... I always felt that he hadn’t been killed by the disease. He’d been killed by the metaphor, by what it meant.”
    —Abraham Verghese, 17:13

  • Despite fear (including his own), some medical staff rose to the challenge while others distanced themselves.

  • Emphasizes the power of simple presence at the bedside:

    “We were able to heal even when we couldn’t cure ... helping the patient, the family, come to terms with this ... this is what the horse and buggy doctor of 200 years ago did.”
    —Abraham Verghese, 19:54

4. Critique of Modern Medicine

Timestamps: 21:50 – 29:49

• Systemic Dysfunction and the “I-Patient”

  • Doctors today are “prisoners of the healthcare business,” spending excessive time on computers and billing (22:07).
  • I-Patient: The virtual representation of the patient in the computer often gets more attention than the real person:

    “The patient in the bed has become a mere icon for the real patient in the computer.”
    —Abraham Verghese, 23:37

• Bedside Ritual and Human Touch

  • Explains the irreducible power and meaning of physically examining patients, not just for diagnosis but for comfort and trust (25:03).

    “We are allowed skilled touch to extract phenotypic information because of this wonderful tradition we have … If you do this well, with skill and pride, you get a kind of buy-in you can’t get if you just walk in the room…”
    —Abraham Verghese, 25:03

• The Hidden Curriculum

  • Laments that, as bedside rounds shrink, trainees lose the chance to witness and absorb meaningful, compassionate behavior (28:22).

5. Doctor Hubris and Systemic Pressures

Timestamps: 29:49 – 31:55

• While the public perceives doctors as arrogant, Verghese sees most as compassionate but ground down by a broken system:

  “What’s interpreted as hubris is often people under pressure and unwell in a very dysfunctional system.”
  —Abraham Verghese, 30:05

6. Hope for the Future of Medicine

Timestamps: 31:55 – 33:20

• Humanism Amid Burnout
  • Physician burnout has become so widespread that systemic change is now recognized as essential.
  • He encourages trainees to “keep the faith” in medicine’s calling despite dysfunction:

    “What I proselytize for is just keep the faith. I love what we do. We’re in a difficult situation now, but ... it’s still a beautiful thing to be in.”
    —Abraham Verghese, 32:16

7. Writing Career and Process

Timestamps: 35:31 – 46:20

• Not a Hobby, but a Calling

  • Insists that writing is not a secondary pursuit, but an extension of seeing the world as a physician (36:42).
  • Advocates for fiction’s power:

    “Fiction is the great lie that tells the truth about how the world lives.”
    —Abraham Verghese, 37:44

• Writing Process

  • Describes a circuitous, discovery-driven approach rather than strict plotting or sequencing (38:23, 39:41).
  • Attended the Iowa Writers Workshop, pausing his medical career to fully devote himself to writing (40:51).

• Data and Storytelling

  • Used a blend of stories, memory, and mapping to shed light on unexpected HIV migration patterns—an example of qualitative research yielding hard insight (42:38, 44:26).

    “To me, the greatest insights come when people recognize that things that we don’t usually call data are data.”
    —Stephen J. Dubner, 44:26

• Portrayal of Goodness and Tragedy

  • Defends his focus on fundamentally good people in his novels, arguing it reflects real life—pain and tragedy intrude, but rarely by design (46:20).

    “Even people who are doing things that are evil, to me ... it might be that they haven’t quite evolved. Their moment hasn’t come. ... I actually would weep when I would get to the sections in the book where one or other character had died...”
    —Abraham Verghese, 46:20

Notable Quotes and Memorable Moments

• “We are trapped. We are actually prisoners in what has become the healthcare business.”
  —Abraham Verghese, 01:17

• “The patient in the bed has become a mere icon for the real patient in the computer.”
  —Abraham Verghese, 23:37

• “This is what the horse and buggy doctor of 200 years ago did. They didn’t have any cures ... but they were able to heal even when they couldn’t cure ... just helping the patient, the family, come to terms ... and the sense of you’re going to make this journey with them.”
  —Abraham Verghese, 19:54

• “Fiction is the great lie that tells the truth about how the world lives.”
  —Abraham Verghese, 37:44

Timestamps for Important Segments

| Segment | Timestamp | |---------------------------------------------------|----------------| | Introduction and Verghese’s early life | 02:27 – 08:24 | | Experience as hospital orderly | 08:45 – 10:32 | | Returning to medicine in India | 10:32 – 11:29 | | Early AIDS crisis and rural Tennessee | 13:49 – 21:50 | | Medicine’s dehumanization and the “I-Patient” | 22:07 – 24:52 | | The power of bedside ritual and touch | 25:03 – 28:22 | | Humility, hubris, and wellness in medicine | 29:49 – 31:55 | | Hope for the future of medicine | 31:55 – 33:20 | | Writing career, process and fiction’s impact | 35:31 – 39:41 | | Attending Iowa Writers Workshop | 40:51 – 42:10 | | Data, narrative, and research on HIV movement | 42:38 – 44:26 | | Goodness, pain, and tragedy in storytelling | 46:20 – 47:54 | | Upcoming works and future plans | 48:19 – 48:54 |

Abraham Verghese’s Current Projects

• Working on a memoir tentatively titled The Body as Text, reflecting on his life and medicine through a medical lens (48:19).
• Beginning notes for a future novel to be set in America, where he now feels fully rooted.

Conclusion

This episode is a testament both to the depth of Abraham Verghese’s insight and his compassion. Through stories of personal upheaval, medical crisis, and literary triumph, Verghese illustrates the need for a more human, patient-centered approach to medicine. He calls for systemic reform, but also for each caregiver to remember the power of ritual, touch, and presence. Whether discussing the art of data, the craft of fiction, or the duty of medicine, he insists on humility, empathy, and the irreducible dignity of every patient.

For more:

• Abraham Verghese’s books, including My Own Country and The Covenant of Water
• Upcoming memoir, The Body as Text (in progress)