by Thomas R. Frieden, MD, MPH / Director, Centers for Disease Control and Prevention
Dr. Thomas Frieden received our 2015 Humanism in Medicine Award at the Arnold P. Gold Foundation’s Golden Thread Gala in New York City. He delivered a remarkable speech that combined individual care and public health into one field supported by humanism. The following is a transcript of his speech:
The single leading challenge all of us face is the integration of public health and clinical medicine. They represent two halves of a whole, and can improve health more by working together closely than either can alone. The big question is how do we do this? And the answer may well be by renewing our focus on the fundamental reason both professions exist – the patient.
The greatest influence on my life was my father, who was a wonderful cardiologist and a consummate clinician. When I was at medical school at Columbia University, the Dean said I could do a preceptorship with any physician for one month. I asked, “Any physician?” She confirmed — any physician. So I told her I wanted to do it with my father, to which she replied, “Great!”
And it was great. I spent my most instructive month of medical school following my father around and learning what it took to be a wonderful clinician. And he was also my secret weapon as a medical student. When I had questions I couldn’t answer, I called him up and said, “Dad, what do I do about this patient?”
I remember one patient in particular for whom I cared deeply. He was an older man, a survivor of Auschwitz, who had a bilateral pleural effusion from end stage heart failure. He was not a transplant candidate and the question was, could we get him more time, even just a little more time to be with his family?
My father said, “You know, sometimes with patients like this, we can tap the pleural effusions, release the fluid, and see how fast it reaccumulates. If it reaccumulates in a couple of days or a week or two, there’s not much you can do. But sometimes it can buy them two or three months. It’s not often, but it is worth a try.”
So I did that. And the fluid unfortunately reaccumulated within just a couple of days. I knew the man well enough to talk with him and let him know what was happening. He said to me, “What I really want is a sip of beer.”
I went to a bodega in Washington Heights and got a can of beer and gave him a sip of it. He savored that single sip of beer with a beatific smile on his face. The nurses were very upset by this, but the attending physician wrote in his notes the next morning, “Patient may have a sip of beer.”
Years later, when I became Director of Tuberculosis Control in New York City, we had one fundamental concept: the patient had to be VIP of the system. We had to organize the system not for the convenience of doctors, administrators or the clinic, but for the convenience of the patient. The world had to revolve around the patient. Not just because that is the right way to take care of patients, but because we are all at risk if TB patients do not have enough support to finish their lengthy treatment regimen.
And that concept – that the patient must be the VIP – is very important. It is not that the patient is always right. It’s not that the doctor is always right. It’s that it is always right to have a conversation, to listen. It’s always right to understand and have empathy.
And that’s the link between the best of clinical medicine and the best of public health, and how we can get these two halves of a whole to work together toward a common goal. In clinical medicine, we listen to the patient, we learn what the problem is, and we learn how to do the best treatment possible.
In public health, we listen to the community, and to the community of patients and clinicians, and we learn what is the best way we can move forward to benefit the most people and save the most lives. The Ebola epidemic in West Africa, the world’s first, presented an incredible challenge. Not only did it unexpectedly hit densely populated urban areas, it hit hardest in communities with 70 percent illiteracy, with a mistrust of both government and modern medicine, and with burial practices conducive to the spread of Ebola. The only way we were able to stop it was by listening to the patients – treating patients as the VIP – and providing patients and communities with the services they said they needed most.
When we do that, it becomes clear that all of us have a common humanity, a common bond. And that common bond recognizes we are all in this together. That all of our fates at some level depend on how well people do in caring for their own health. That all of our fates depend on some level on how well we as a society do in caring for our patients.
Today in medical care, we have lots of challenges. We have the challenge of the short term vs. the long term. Of listening vs. communicating. Of leading vs. following. Whether it is drug resistant bacteria and the need to talk to patients about getting the right treatment, not the most treatment. Or pain management and the need to talk about the risks and benefits of different pain therapies so that patients can live long and health lives free from both pain and addiction.
It’s not just about the right answer. It’s about the right communication, and above all it’s about listening. The best answer for each patient, each time, and the best program for each community.
Humanism in medicine is enormously important. I would add one more incredibly important “ism” – optimism about the future. Because even when the prognosis is not what we wish, we have a commonality. We have an ability within the health profession to bind together as patients and clinicians, communities and leaders, and communities, countries and the world. By doing that, we have the ability to build a better, healthier and more rational future for all of us.
