Doctors who rely on hands-on skills tend to order tests more judiciously. They become partners in a healing process along with the patients.

You also wrote that in a health care system 'in which our menu has no prices, we can order filet mignon at every meal'.

There is no need for many of the tests doctors order. In India, if a doctor ordered a series of tests and the patient had to pay from his or her pocket, don't you think that the patient would ask the doctor if all the tests are necessary? Here (the US), it is like more the merrier.

And the reason seems to be obvious.

The tests make a lot of money. We talk of our health care industry here. But when the industry part gets more prominence, and the idea is to make a lot of money, the patients suffer. We read about millions of people turning to alternative medicine.

I am not surprised that people seek out alternative medicine in droves. Those people put their hands on a patient, they get to know the patient as a person.

How did this come to happen?

It is easy to blame the healthcare industry. But let us look at medical education and educators. How did we reach this state of affairs, we should ask. I believe that to a large extent the fault is ours as teachers of medicine.

What can the medical schools do?

They can learn from what happens in a good hospital in India or from the Canadian health system. Patients should also be aware of what is missing in our system. We have a situation which is like licensing pilots without ever having been in the air with a trained examiner.

What do doctors miss out when they do not get to know the patient at their bedside?

Being a doctor is also about getting joy, excitement, and intellectual pleasure from what we do. It is about learning from our disappointments and mistakes; it is about humility. There is nothing more valuable than a trainee learning from the real patient's body.

Isn't the iPatient phenomenon also happening in India?

The iPatient is very much a danger and already happening in India where technology in medicine particularly in the private sector is in the ascendance. Also just as it is here, the money to be made is not so much in spending time with the patient but if you own a cat scanner in getting people through it. That said, I think bedside skills in India among the teachers of medicine are phenomenal.

Why are the residents trained anywhere in America think alike when it comes to the iPatient?

It is because the technology dependent style of practice is as uniform as McDonalds.

What drew you to medicine?

It came in the form of a book when I was about 12 when I read Somerset Maugham's Of Human Bondage. Philip in that novel sets out to be an artist, but fails. He discovers though he has passion for medicine. After years of struggle and slogging, he finally becomes a doctor in London and when he visits the outpatient clinic, then, he realises he has made the right choice. There is a line in the novel which spoke into my heart at age 12: 'There was humanity in the rough, the materials the artist worked on; and Philip felt a curious thrill when it occurred to him that he was in the position of the artist.'

Why did the passage mean so much to you?

It has haunted me for four decades. The phrase 'humanity there in the rough' spoke directly to me as a 12-year-old reader. I took it to mean that if one had no God given talent to be an artist (or a mathematician), one could aspire to be a doctor, perhaps even a good one.

I have come to believe over the years that the beauty of medicine is that it is proletarian, and its key prerequisite is that you have an interest in humanity in the rough. Many of us come to medicine because we are wounded in some way. In my novel, Thomas Stone (an English doctor in Ethiopia) is a great example, and so is (his son) Marion Stone.

You are a committed physician and teacher. You say that practising medicine makes you humble. And yet this was not your first love.

Fiction has always been my first love. The novelist Dorothy Allison wrote -- and I am paraphrasing it here -- fiction is the great lie that tells the truth about how the world really lives. I use Tolstoy's The Death of Ivan Ilych to teach the students about the end of life, and Allison's Bastard Out of Carolina to help students under child abuse. A textbook rarely offers them the truth and insights found in the best novels.

You have written two acclaimed works of non-fiction. Then you switched to a novel.

In a way, it would have been easier to write a work of non-fiction and non-fiction books sell much more than novels in most cases. But I always wanted to write fiction. When I grew up in Ethiopia and then studied in Chennai, I did not know if I could be a full time writer.

I went into medicine because I loved it. But I never gave up the passion to write. When you write non-fiction, you are aware that readers have a strong interest in things that really happened. Just look at how many books came out of the O J Simpson story.

Image: Dr Verghese with his students at Stanford.

Also read: 'Writing is an intimate dialogue'

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