FEATURE medical schools , patient care facilities , and other organizations to show their support of the importance of kindness to patients . Typically held on or near Valentine ’ s Day , the Solidarity Day expanded to a National Solidarity Week this year . 5
Members also participate in the “ Tell Me More ” program , which was developed in 2014 by GHHS chapter members at the Icahn School of Medicine at Mount Sinai . The project personalizes a health-care provider ’ s interaction with patients by encouraging that person to spend time learning about his or her patients ’ personal lives and asking three simple questions : What are your strengths ? How would your friends describe you ? What has been most meaningful to you ? The physicians then crafted signs based on these answers to display at the end of patients ’ beds as a reminder that each patient is an individual . 5
“ This program allowed us to get to know them as people as well as patients ,” Dr . Schiffman said .
At Memorial Sloan Kettering Cancer Center , Dr . Gilewski started a monthly “ Art of Medicine ” lecture series to emphasize some of the human elements of cancer care . “ We have multiple lectures and guest speakers , including patients and family members , who offer their perspective on illness , suffering , and grief ,” Dr . Gilewski said . “ The whole point is to highlight this aspect of medicine for everyone working in the institution , not just for physicians , nurses , and pharmacists , but also administrators , assistants , and others . We all know the human element exists , but we often don ’ t pay enough attention to it in a formal way .”
A Self-Care Curriculum
Definitions of humanism outline qualities designed to help doctors make the doctor – patient visit more “ humane ,” and it is important to remember that the doctor – patient relationship involves two humans – and both need to be cared for .
Physician stress , like physician empathy , has a tangible effect on patients ’ experiences and patient – physician communication ; the German study from 2007 demonstrated that as physicians ’ reported stress levels rose , patients were more likely to report a desire for more information from the physician regarding findings and treatment options . 2
“ Self-care is one of the universal obstacles that all physicians are confronting every day ,” said Dr . Kesselheim .
The demands of modern-day medical practice can make a physician feel less than human , she said . Today ’ s practicing physicians face more complex administrative duties and a higher demand for detailed documentation than in the past , and , with work-hour restrictions , doctors spend more time doing patient hand-offs .
“ In many of these situations , physicians are not getting the privilege of engaging in human connections with their patients but instead are spending time doing documentation or care coordination in the background ,” Dr . Kesselheim said . “ All of that can be draining and can make them feel frustrated .”
Human interactions with patients suffer , and a physician ’ s own human experience may no longer be a priority .
“ Self-care is hard ,” Dr . Gilewski noted . “ It is not easy to care for people who are ill and for that to not have some sort of emotional impact on the physician . Physicians need to have something to turn to , to help sustain themselves and continue to do this work on a daily basis .”
For some physicians , that might be a commitment to physical activity ; for others it may be the arts , a love for music , or spirituality . But , for all physicians , self-care should involve open conversations among colleagues about their experiences and day-to-day challenges .
Dr . Kesselheim has piloted a program at 10 fellowship programs across the country , which brings fellows together in a group discussion about cases that illustrate challenges to humanistic medicine . Facilitated by a trained faculty member , these sessions provide an opportunity for trainees to talk through the case and devise coping strategies consistent with the kind of doctoring that is important to all of them , Dr . Kesselheim explained .
A recent session focused on maintaining an appropriate work-life balance as a fellow . In one case , a fellow recalled a stretch of particularly
”What would every selfrespecting health system have in an era where humanism was fully expected to be integrated into medicine ? That discussion still needs to happen .”
— LINDA EMANUEL , MD , PhD
stressful days . He had been looking forward to an anniversary dinner with his significant other , whom he had not seen recently due to weekends spent on-call at the hospital . However , in clinic that day , he had to stay late to meet with the family of a patient whose leukemia had relapsed , causing him to be late for the anniversary dinner . The next day , the fellow ’ s mentor asked to see a first draft of a research grant with a fastapproaching deadline , and the fellow had to admit that he had been unable to work on the draft . So , as he explained during the group discussion , the fellow now has a patient who has relapsed , a disappointed mentor , and an upset significant other .
“ When we discussed this case , all of the fellows nodded their heads in agreement because each and every one of them knew that this type of thing happens all of the time ,” Dr . Kesselheim said . “ They don ’ t usually get to talk about it , but in this group they were able to ask how others dealt with these types of conflicts and what tricks or coping mechanisms others had .”
Bringing Back Humanism
According to Dr . Emanuel , one of the great questions in medicine is : What would medicine look like if humanism in medicine was what it should be ? Certain institutions seem to focus on integrating humanism in medicine , and those often have a physician-leader championing and putting humanism programs in place .
“ But , I do not hear discourse about what medicine would look like if humanism were properly integrated ,” Dr . Emanuel said . “ What would every self-respecting health system have in an era where humanism was fully expected to be integrated into medicine ? That discussion still needs to happen .”
In the meantime , as the role of humanism continues to evolve , there are measures that physicians can take to inject humanism into their everyday routines – for the benefit of their patients and themselves .
For Dr . Kesselheim , one such action is trying to leave all of her other concerns outside the door as she enters a patient ’ s room , turning her entire focus to the patient and the visit . “ I try , whenever possible , to turn away from the computer and speak directly to the patient , saving documentation for later if possible ,” Dr . Kesselheim said . “ Even when I feel rushed , I try to make sure to let the patient voice be heard and make sure that the patient is allowed to say everything he or she needed to say during our clinical encounter .”
Providing your undivided attention is just one of the many “ little things ” that physicians can do to promote healthful , healing relationships with patients , Dr . Schiffman said . Other simple tactics include introducing yourself and everyone on the care team as well as greeting each person in the room during a clinic visit .
“ Be still , be open and interested ,” he said . “ Turn off your beeper and be in the moment when you examine patients .”
Finally , another easy way to incorporate humanism into patient interactions , as demonstrated by the GHHS “ Tell Me More ” campaign , is to ask patients just one or two personal questions , according to Dr . Gilewski . “ It is a classic example , but just ask about their family or work , or if they have been on a trip ,” Dr . Gilewski said . “ It changes the entire tone of the session .”
She added that understanding the human aspects of medicine has an unending learning curve that will change as physicians gain more professional and personal experiences .
“ Even though a lot of physicians strive for perfection , we will not always be perfect at it ,” Dr . Gilewski said . “ Sometimes it can be hard to reflect on those moments , but that is an important part of medicine as well .”— By Leah Lawrence ●
REFERENCES
1 . The Arnold P . Gold Foundation , “ What is humanism in health care .” Accessed April 3 , 2016 from http :// humanism-in-medicine . org / about-us / faqs .
2 . Neumann M , Wirtz M , Bollschweiler E , et al . Determinants and patient-reported long-term outcomes of physician empathy in oncology : a structural equation modeling approach . Patient Educ Couns . 2007 ; 69:63-75 .
3 . Alliance for Academic Internal Medicine , “ Collaborative for healing and renewal in medicine ( CHARM ).” Accessed April 3 , 2016 from http :// www . im . org / p / cm / ld / fid = 1403 .
4 . The Schwartz Center for Compassionate Healthcare . “ Schwartz Center Rounds .” Accessed April 3 , 2016 from http :// www . theschwartzcenter . org / supportingcaregivers / schwartz-center-rounds .
5 . The Arnold P . Gold Foundation , “ GHHS Solidarity Week for Compassionate Patient Care .” Accessed April 3 , 2016 from http :// humanism-in-medicine . org / ghhs / national-conferences-events / ghhs-solidarity-day .
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