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In this episode, we sit down with Francisco M. Torres, an interventional physiatrist and author of Beyond Diagnosis: Perspective in Medicine and the Human Experience. Join us as we explore the theme of humanizing medicine in an era of increasing standardization and technological advancement. We discuss the profound influence of humanities, history, and philosophy on medical practice, the challenges young doctors face in balancing technical expertise with compassionate patient care, and the potential role of artificial intelligence in restoring the human element in health care.

Francisco M. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine and can be reached at Florida Spine Institute and Wellness.

He discusses his book, Beyond Diagnosis: Perspective in Medicine and the Human Experience.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Francisco Torres. He’s an interventional physiatrist, and we’re going to talk about his book Beyond Diagnosis: Perspective in Medicine and the Human Experience. Francisco, welcome back to the show.

Francisco Torres: Thank you so much for having me again, Kevin.

Kevin Pho: So Francisco has been on multiple times. Go to KevinMD.com/podcast to search for his name, hear his story and prior episodes. But today we’re going to talk about his book Beyond Diagnosis: Perspective in Medicine and the Human Experience. There’s an excerpt of that on KevinMD. So Francisco, tell us about your book.

Francisco Torres: Well, it’s an interesting story, because for me, I’ve been a doctor for over 30 years now, and during that time, most of the time I’ve been reading books about diet, nutrition, exercise, everything related to the medical field, more technical.

And when the pandemic started, when COVID-19 hit us in 2020, there was more time, it was just more freedom to start using my head for additional thoughts. And I was confronted for the first time having to see patients through telemedicine. For me that was new, I had never done that besides a phone call.

So my first patient, one of my patients during that time, was kind of a little bit of a shock. This gentleman, in the middle of the interview, when I was doing the depression inventory scale test, he decided to pull out a pistol from his drawer.

Kevin Pho: Wow.

Francisco Torres: When I asked him if he had any thought about suicide. But the good thing, at the end, when you look backwards, he was just joking, that the pistol was not loaded. However, oh my goodness, all my cortisol levels went up, I didn’t know what to do.

And the way I handled that at the end was, because he was joking, he was just being himself. But then it kind of made me think, oh, other doctors may have this possibility of an encounter with patients that they never thought about, and then what do you do?

So in that essay, which was published in Doximity, and I won an award that year, was that I prepared the doctors, telling them, one other thing I decided to do was to have direct access to my assistant in case of an emergency. Also I told my assistant to get a phone number from a relative or a friend not in the house, and also have a physical address if I had to send the police. So after that I was more comfortable doing these interviews.

But the other thing that was shocking at that time was that, we are so concerned about diagnosis, to be sure that we have the right blood work, the tests done. But when you see these people in their own home, how they live, how they dress, how they behave, it tells you that there is a psychology behind all these elements, and you need to pay attention. And that’s what my first essay was. And then after that I said, I have so many stories, I started putting them together, and you were so kind to publish a lot of them, and I have had a really good reaction from many doctors.

Kevin Pho: So what are some of the themes that permeate throughout the book? So I think that your book, of course, is titled Perspective in Medicine and the Human Experience, so I think that you do want to focus on that human aspect of medicine despite all the technology that is advancing medicine. And you mentioned telemedicine, and we have AI, and there are so many technological influences that we have in health care that can sometimes affect that human experience.

Francisco Torres: Absolutely. And I think, what I’m trying to, my message is, technology is good. I do believe that artificial intelligence and technologies like that are going to allow us to spend more time interacting with a patient, rather than trying to guess the diagnosis and how we come up with a plan. So I think that’s going to allow us to interact.

But again, going back to experiences, one of them was very shocking. I had this older lady, I treated both the husband and the wife for many years, and she lost her husband after having a long course of dealing with lung cancer. And then she came to tell me that, and I apologize, but at that time I was a little bit in a hurry. I wanted to be sure that I addressed her issue, but that was it. And she told me that she was going to run a marathon. And I look at her, I say, you know, she’s in her late 60s, never exercised, never a runner. Physically, I said, OK, good luck, thinking, oh yeah, she’s not going to do it.

And then later on she came, several months later, she was full of life, she was saying that she was running more. But then all of a sudden she stopped me and said, you know, Dr. Torres, the reason I wanted to run the marathon, it was not in my husband’s honor, it was, I wanted to kill myself, I was depressed.

And then when she said that to me, wow. She used that to try, because she was very religious, she didn’t want to kill herself, but she thought that by stressing herself in a marathon she was going to die. So it kind of made me think, you know what, I talked to that patient, it never crossed my mind about the possibility that she was depressed or suicidal. So that was an awakening.

Kevin Pho: So with all the non-human aspects in medicine today, and we talked about technology a little bit, but now you have metrics and patient satisfaction and clinical best practices, how do you maintain that humanity in health care in the exam room?

Francisco Torres: It’s a challenge every day, particularly, we talk a lot about the burnout syndrome, and I think that burnout syndrome is the fact that we’re seeing too many patients, because with the reimbursement going down, we need to compensate with volume the lack of reimbursement. And also administration, and even now private equity buying out the clinics, because we’re all burned out, want to get out of it, but then the private equity comes for the profit, not so much for the patient. So it’s a challenge, I have to say. And if we’re not mindful of what we’re doing, I think we’re going to be having some issues later on.

You know, I was reading this statistic, the doctor’s attention when he goes into a patient room, it’s only 18 seconds before the doctor interrupts the patient. So that patient only has 18 seconds to be sure he connects with that doctor.

Kevin Pho: So that tells you, so what do you do in the exam room knowing those statistics, and how do you maintain that focus and human connection?

Francisco Torres: Yeah, Kevin, I think I’m blessed because my personality, I’m very social. I try to keep the eye to eye contact. I am very touchy-feely, and again, that is a little bit controversial, but I don’t know why, the patients give me hugs.

And also I do procedures like electrodiagnostic studies, which I have a bunch of stories from there, that you have to touch the patient with the electrodes and put a needle. So you spend 45 minutes with a patient in a room together, so there’s a lot of, it’s like a confessional. The patients start to be more relaxed, and then get to the point that it is your body language and the way you speak. We know that our words matter. So if they sense that you’re in a hurry and you’re not putting a little bit of effort to understand where they’re coming from, I think that’s when we fail.

Kevin Pho: In your excerpt you talk about medical education and maybe incorporating some of the humanities to foster more empathetic and well-rounded physicians. So let’s talk about how important it is for the humanities, especially in these new doctors that are coming up, and medical students and residents.

Francisco Torres: Well, that’s a great issue, because one of the things, I have medical students, I have fellows, and my understanding now is the universities, the colleges, they’re not promoting liberal arts. They even want to eliminate liberal arts. Many colleges are eliminating, they want to go to the technical part, mathematics, physics, biology, chemistry.

So I think my experience with, when I was going through college and exposing myself to psychology, to philosophy, and all these different matters, that helped me to grow as a person, and I can interact with patients better. If I didn’t have that, I don’t think I would be the same person, the same doctor I am right now.

And it’s funny, because there’s a lot of people, motivational speakers and people out there, talking about the philosophers and going back to that time. And I think in medicine we’re lacking that. I think it should be part of our curriculum to incorporate that.

Kevin Pho: So what are some of the other themes that connect the stories in your book?

Francisco Torres: Yeah, it’s always a possibility that, like for example, I had a personal one with my mother, when she broke her hip, she went to the hospital. And I know I’m a doctor, but I didn’t want to get involved in the care. But in my mom, it crossed my mind, the possibility of blood clots, but I was not strong enough to tell the doctors, be sure, because I thought that they were taking care of that.

The bottom line, I talk in that essay about intuition, that as a doctor we have intuition, and we need to pay attention to that, because my mother died from a blood clot. Unfortunately, it was not anybody’s fault. But the funny part, Kevin, about all these essays, is the reaction from doctors. They start questioning me, saying, there’s no intuition, intuition is your latent knowledge and you have it in the back of your brain. But I said, no, that is what we’re missing, really. Intuition doesn’t have to be because we already have that knowledge. Yes, that helps, but it’s something inside, that internal mechanism, that if we don’t pay attention to it, we don’t use it. That essay is basically about that.

And then another one that I had, because I lost a couple of dear doctors in my life with cancer at a relatively young age, and all that, and I talk about that. I normally do every year, I go through, like, I’m pretending on writing my own eulogy. And I’ve said that because a lot of professionals do that as a norm. But the reaction from the doctors, Kevin, was that I was selfish, that, don’t think about your death, think about the patient’s death. I said, well, you missed the point. It’s just to be sure that you understand that life is very, very short, and then you need to pay attention to your surroundings. So that’s it.

Kevin Pho: So let’s get back to some of the things that you said about intuition. I thought it was pretty interesting. So what would be an example where you feel that intuition is being lost, and maybe talk about how intuition helped you with the care of a patient?

Francisco Torres: Well, many times, Kevin, it had been not proceeding with care of that patient, because I felt like, this is not, I’m not the right person, we’re not connecting the right way. And at the end it was a blessing, that I followed my gut, not because there was anything particular about that interaction, it was just some feeling that I was uneasy with it, and I said, I’m not the one.

The problem is, Kevin, that sometimes we can have fear, but that’s different, that’s physiological. Intuition is more, I would say, supernatural, more spiritual. I’m not saying fear about doing a procedure because you feel that you’re going to fail. No, it’s just something inside of you that says, don’t proceed with that, or call somebody at that time to see that patient, or have a consult, or something. But if we don’t pay attention to that, then I think we miss the opportunity to improve our clinical judgment.

Kevin Pho: So speaking of clinical judgment, you touched upon the physical exam in your KevinMD excerpt, right? And as you know, the physical exam isn’t as thorough, and it’s kind of going by the wayside because of time pressures. Sometimes it’s easier to just order a test or send a patient to a specialist, because we only have 5 to 10 minutes with the patient in the exam room. Talk about how important a physical exam still is today, and how you use that to maintain connections with patients.

Francisco Torres: Well, I think the first part of the physical exam, you have to touch the patient, and that just shows the patient that you care, that you’re paying attention to the complaints.

And the other thing is that I have seen patients that had a surgical scar that nobody saw, that only when you’re doing a procedure, nobody saw that the patient has a surgical scar. We have to figure that out when the patient is on the table for some type of injection or procedure. Or that they have scoliosis, that’s one that, for me, that’s the one that I see all the time.

And then, I don’t know, you feel kind of stupid. And they ask, do you know I have scoliosis? But when you do the physical exam, that’s pretty obvious, you can see it, and you can tell the patient, oh, you have scoliosis. So again, it’s just establishing the trust between you and the patient. That’s basically what I think the physical exam is.

I know that there are moments that they say, well, this doesn’t help me, but at the same time, at least it helps you to rule out all the possibilities. The patient has a good range of motion of the arm, but doesn’t have adhesive capsulitis or frozen shoulder. At least things like that, versus, oh yeah, the patient has pain, the X-ray shows arthritis. So again, it gives you credibility.

Kevin Pho: Tell me who the audience is for your book, and what kind of messages you want them to come away with after reading it.

Francisco Torres: It was interesting, because when I started writing them, it was mainly for doctors, to be honest. Just like a sharing. And it kind of worked, because I have a couple of my colleagues telling me, oh my goodness, you have described things that happened to me and I never read this before.

Like when I went to Haiti for the mission work, oh my goodness, I volunteered, I have all this anxiety because I felt unprepared. And all of a sudden two doctors went through the same experience. So I’m trying to say, well, if you read about it and you haven’t done it yet, let’s just prepare for that. So I’m giving you some heads up to go through that. But now I share with my patients and they like it too. My patients, we have a connection because of that too.

Kevin Pho: We’re talking to Francisco Torres. He’s an interventional physiatrist, and we’re talking about his book Beyond Diagnosis: Perspective in Medicine and the Human Experience. Francisco, we’ll end, as always, with your take-home messages to the KevinMD audience.

Francisco Torres: I think that the main thing is to try to maintain that human connection in medicine, to do as much as we can, I know within our limitations, to at least pay attention to little details, establish sometimes eye to eye contact, a little bit of a touch, a hug.

So specifically ask questions about their life as well, because I think that’s part of the history we’re forgetting about, getting a little bit of details about their family, social situations. I think that my purpose is to bring intentional awareness that that needs to be done when you’re interacting, no matter if you do it in five minutes or 10 or two minutes. I really think we need to pay attention.

Kevin Pho: The book is called Beyond Diagnosis: Perspective in Medicine and the Human Experience. Francisco, thank you again for coming back on the show and sharing your time and perspective.

Francisco Torres: Thank you so much, Kevin. I appreciate it.