Why Doctors Can't Feel What They Do — And What Happens When They Finally Can
In an emergency trauma situation, a medical resident failed to detect a blood clot in a patient's heart. Carla Pugh did. The patient survived because Pugh intervened, but the incident haunted her.
Years later, at TEDMED, she posed the question that would define her career: Why didn't the resident feel the clot when I did? Was the resident not pushing with enough force? Athletes get instant replay feedback, why don't doctors have access to similar technology?
Pugh, a surgeon and professor at Stanford University's School of Medicine, has spent more than a decade building technologies that answer that question. Her work at the Technology-Enabled Clinical Improvement Center focuses on quantifying haptic skills — the tactile techniques doctors use when they press, probe, and feel for abnormalities beneath the skin.
The medical field has long relied on these physical examinations, yet unlike surgical technique or diagnostic reasoning, touch has remained stubbornly unmeasurable.
A Problem Discovered Through Frustration
She didn't arrive at this problem through engineering. She arrived through frustration.
Early in her training, Pugh realized there was no way to objectively assess whether a clinician was applying the right amount of pressure, moving in the optimal pattern, or developing the sensitivity that distinguishes an experienced examiner from a novice.
The solution, she understood, required expertise she hadn't yet acquired. So she pursued a Ph.D. in Education from Stanford — becoming the first surgeon ever to earn that distinction — before returning to the institution years later as a professor of surgery.
Pugh's approach combines video recording with sensor motion trackers to capture exactly what happens during physical examinations.
Her breast exam simulators, embedded with pressure sensors, have revealed that roughly 15 percent of clinicians fail to apply proper force to detect lesions during routine screening.
The data doesn't judge; it simply measures. Most of the clinicians want to know how their performance measures up to their peers. The response at medical conferences has been striking — clinicians lining up by the hundreds to test their sense of touch on her simulators, hungry for feedback they've never received.
More than two hundred medical and nursing schools now use one of her sensor-enabled tools for student training.
She holds three patents on the underlying technology, and in 2011, received the Presidential Early Career Award for Scientists and Engineers.
But Pugh considers her current work a stepping stone toward something larger. She has spent years defining gold-standard performance metrics using mannequin-based simulators, analyzing data from hundreds of clinicians performing identical examinations. Now she wants to move beyond the mannequins.
Moving Beyond the Mannequins
Her next phase involves placing wearable sensors directly on patients to collect real-time data during actual clinical encounters. "I believe this will redefine medical training and accurately represent what it takes to care for patients," she explained.
The challenge is not purely technical. It is cultural. Medicine has always taught that competence in physical examination comes with time and practice, but without objective measurement, the pathway to mastery remains opaque.
Pugh's sensors make the invisible visible — transforming intuition into data, and experience into evidence.
She is also candid about the barriers she has navigated as a woman in surgery and engineering. The grant application process can be particularly punishing: research shows women are significantly less likely to resubmit after rejection, an attrition that compounds over careers.
Her advice to emerging researchers is blunt: never give up. She points those facing obstacles toward Reshma Jagesi at the University of Michigan, whose work on gender equity offers practical guidance for navigating academic medicine.
Pugh's vision — sensors on patients, real-time performance feedback in the clinical environment — remains unfinished. But the infrastructure is in place. The metrics are defined. The simulators are in use.
What she's building is not simply a measurement tool, but a new language for describing what doctors' hands know.
Based on: Why Doctors Can't Feel What They Do; Carla Pugh at TEDMED; Stanford University School of Medicine.