Having recently done some research and writing about Penn Medicine’s new Academy of Master Clinicians and the Penn Pearls awards that medical students give out for clinical teaching, I found myself drawn to an article in the most recent issue of Academic Medicine. Its title: “Attitudes and Habits of Highly Humanistic Physicians.” The article begins by defining humanism in medicine as the combination of “scientific knowledge and skills with respectful, compassionate care that is sensitive to the values, autonomy, and cultural backgrounds of patients and their families.” But the authors immediately add that this concept –- as worthy as it is, as essential as it may appear –- has foundered over recent decades “as medicine evolved into an increasingly analytic, biomedically focused field.” Are humanistic physicians then an endangered breed today –- or perhaps a distinct minority? What can be done to support them?
All three of the authors, in fact, are working to answer these questions right here in the Perelman School of Medicine. Carol M. Chou, MD, is an associate professor of clinical Medicine; Katherine Kellom, BA, is a senior research coordinator for the Department of Family Medicine and Community Health; and Judy A. Shea, PhD, is a professor of Medicine, associate dean for medical education research, and interim chief of the division of General Medicine. They note the demonstrated benefits of humanistic medical care, from improved patient satisfaction to improved health outcomes. Humanistic physicians certainly exist -– and, as I’ve suggested, Penn Medicine makes a special effort to acknowledge them -– but the authors are especially concerned about the physicians’ outlooks and attitudes as they move on in their careers. “In an era of proliferating technologies and increasing financial, academic, and productivity pressures, how do physicians maintain their humanistic outlooks over time?”
To find the answer to their question, the authors administered a questionnaire to all 161 internal medicine residents at the University of Pennsylvania in June 2011. The residents were asked to name up to three attending physicians who they believed served as excellent role models for the practice of humanistic care. Then the physicians who were named most frequently were invited to take part in one-on-one interviews with Dr. Chou. Of the 16 attending physicians (7 male and 9 female) selected, all participated. The mean age was 40.1 years, suggesting that many had moved beyond an early stage of enthusiasm but were still holding on to their humanistic attitudes.
What did the authors find? Six attitudes stood out: humility; curiosity; standard of behavior; importance for the patient medically; importance for the physicians; and “more than just the disease.” In recent years, newspapers like The New York Times have run stories about brusque, apparently indifferent doctors who make almost no human contact with their patients. In contrast, as one of Chou’s respondents eloquently put it: “We are very honored that these patients allow us to see them naked in bed, wandering to the bathroom, and then we ask them really in-depth personal questions the first time we meet them. And it’s really an honor that they trust us just because we have this degree behind our name.” Another respondent, characterizing the standard of behavior they seek to maintain, noted “it’s how I would want to be treated, so I try to treat the patient that way.”
The habits these physicians regularly practice are: self-reflection; seeking connection with patients; teaching/role modeling humanism; striving to achieve balance; and mindfulness and spiritual practices. I found it interesting that they view teaching and being a role model to be a useful impetus. According to the article, “The presence of learners serves as a constant reminder to these physicians of the standard of humanistic care.” Or, as one of the respondents puts it pithily, once you’ve interacted with the house staff, you feel an obligation “to live up to what you say.”
The authors also address the matter of burnout. After all, if highly humanistic physicians are investing so much of themselves in their interactions with patients, it would not be a surprise if they experienced a corresponding sense of failure or grief when patients do not fare well. In addition, there is the danger that the humanistic approach can threaten the physicians’ necessary balance of work and life. What Chou, Kellom, and Shea found, however, is that half the physicians interviewed believed that treating patients humanistically could actually be “the antidote” to burnout. Another finding –- which, the authors suggest, “has implications for institutional policies that could be implemented to improve the delivery of humanistic patient care” -– is that their respondents identified the external environment as an important factor in fostering humanism. Having other caregivers as well as a broad support system with, for example, a cancer center, counseling services, and other resources for patients provides a welcome boost to the physicians.
This spring, the Perelman School of Medicine held its first induction ceremony for the Gold Humanism Honor Society, a program developed by the Arnold P. Gold Foundation. The Foundation, which began in 1988, was conceived to counter what it considered a disturbing trend in medicine: the ascent of science at the expense of patient care. According to the Foundation, “Physician trainees were scientifically proficient and technically well-trained, but often demonstrated a sad lack of caring and compassion.” A familiar complaint! One way to encourage a radically different approach was the Honor Society, which recognizes medical students, residents, and faculty members who practice patient-centered care “by modeling the qualities of integrity, excellence, compassion, altruism, respect and empathy.” Those are the same qualities recognized in Penn’s “Master Clinicians” as well, so there are two recently established programs at Penn Medicine to encourage humanism.
As for the medical students, since the introduction of the Curriculum 2000 program in 1997, all of them take a specific course module whose goal is to preserve and promote humanism, multi-culturalism, and idealism in the pursuit of medical education, the cultivation of medical collegiality, and the development of the doctor-patient relationship. The hope is that Penn’s students will develop into the kind of humanistic physicians worthy to be named Master Clinicians, no matter where they practice.
Image: Hippocrates, advocate for humanistic medicine