April 24, 2003
Humanist Approach a Must in Medicine
Ritual and tradition are central.
Medical practitioners today are faced with onerous economics and an increasingly depersonalized and technically complex health-care system. This reality presents serious challenges to practicing humanistic medicine. It is therefore especially important now to value and re-emphasize the intrinsic connection between compassion and competence in the practice of good medicine.
In the early 1980s, I began to notice that my students seemed to be more engaged in science and technology than taking care of people. Why? Did medical students begin school with idealism, altruism, compassion and empathy, only to have it depleted during their educational experiences? Or, was the medical admission process simply selecting less-humanistic applicants?
Research examining the attitudes of 3,500 entering medical students from across the nation concluded that most were indeed empathetic and humanistic when they began their studies. Clearly, some time during medical school and the end of the residency experience, many caring young doctors change. Why do some students maintain a humanistic orientation while others lose it?
How can we teach medical students a more humane approach to medicine and promote a medical system that fosters relationship-centered care? Nearly 15 years ago, colleagues at the Columbia University College of Physicians and Surgeons, philanthropists and community leaders co-founded a public charity, the Arnold P. Gold Foundation, to create opportunities for meaningful ritual, recognition, role modeling and research, as well as national conferences, curricular change and building "caring hospital communities." These programmatic themes (the four Rs and three Cs) are customized for the four populations we serve: medical students, medical school faculty, hospital residents and the public.
Ritual and tradition are central to Judaism and to the work of the foundation. We encourage medical students to make a psychological contract -- to incorporate compassion as part of their professional responsibilities through the public recitation of a professional oath. Foundation programs such as the White Coat Ceremony, a rite of passage for entering medical students, and the Student Clinician's Ceremony, for third-year students beginning their relationships with patients, provide an opportunity for reflection and a renewed commitment to humanistic values.
The Hippocratic Oath, written 2,500 years ago, has been a keystone for physicians throughout history. Its admonition to "do no harm," treat patients with respect and to "lead lives of uprightness and honor" is taken seriously throughout Western medical education. Jewish tradition embraces these same ideas, as well as additional ethical and spiritual considerations. The Physician's Oath and Prayer, attributed to Moses Maimonides, the 13th century physician and philosopher, articulates ancient Jewish values and goes beyond the Hippocratic Oath in delineating appropriate behavior and practice. In his prayer, Maimonides speaks about social justice in medicine: "May I never see in the patient anything but a fellow creature in pain," acknowledging the potential biases of wealth, power and personality as barriers to equal treatment for all patients. It is important that all practitioners develop both skills and values that reflect these oaths.
Medicine is an apprenticeship profession, where humanism can be taught and behaviors associated with humanism can be learned. Medical students are quick to adapt to formal curricular expectations; they also absorb the attitudes, habits and ethics found in the cultural environment. In other words, students of medicine at all levels imitate role models, adjust to the culture in which they work and adhere to the values expressed or demonstrated by their teachers and peers. Therefore, if we teach the role model humanism as "the best medicine," we will create more humane physicians. Such competent caring will increase trust, enhance the healing process and result in better patient outcomes.
A growing focus on physician professionalism has instigated a strengthened interest in humanism and its role within the definition of "the professional." This bodes well for greater pressure within the medical culture to include the art and "habit of humanism" in its formal and informal curricula, and in accreditation criteria and standards. If we are to be successful in challenging the negative pressures from commercial and legislative interests, we will need an educated and vocal public to partner with like-minded professionals. We invite you to join us in this struggle to re-emphasize humanistic medicine.
In sum, what is the role of a physician? A humanistic physician demonstrates concern and respect for the values, autonomy and cultural and ethnic background of others, and provides skilled, compassionate and empathic help to someone with a problem or need.
Reprinted from the Journal Sh'ma, a service of Jewish Family & Life!
Dr. Arnold P. Gold is professor of clinical neurology and clinical pediatrics at Columbia University College of Physicians and Surgeons.