Humanism in healthcare has so many faces.
Humanism in healthcare can show up in doing laundry for the homeless or in an academic study measuring the impact of implicit bias.
Humanism in healthcare can be a call to recognize that the human patient in the exam room should take precedence over the “computer patient” that is the needy electronic medical record.
Humanism in healthcare can be recognizing that many patients come with burdens other than what they are seeking care for, but which affect their care nonetheless. They could be veterans, or domestic violence survivors or refugees or survivors of discrimination across transgender, religious and racial lines.
All of these faces of humanism – and many more – were on display during the pre-conference symposium to the Gold Humanism Summit in October that featured project presentations from Gold Humanism Honor Society (GHHS) and Mapping the Landscape (MTL) initiatives. GHHS members and MTL grantees came to Orlando, Florida, for this one-of-a-kind gathering on October 26-27, 2019.
“All of you have made a serious commitment to humanism in healthcare,” said Dr. Richard I. Levin, President and CEO of The Arnold P. Gold Foundation, in his opening address. “You represent its future and the future of healthcare itself.”
Dr. Levin’s opening remarks were encouraging and hopeful. Listening you would never suspect that he himself has struggled with hope.
But, after just the first set of presentation of projects by GHHS students, given on an early Sunday morning, Dr. Levin appeared energized. He admitted that for some time now he had been “despairing over how we will crawl out of this moment of anti-humanism that we are in.”
But he was despairing no longer.
“This generation will take care of it!” he said. “Thank God!”
In the space of a morning, Dr. Levin had both given and received hope for the future.
This give and take of hope, empathy, and support was evident throughout the GHHS & MTL Symposium – often in humorous and heartwarming ways.
Take Dr. Zach Dawson, who presented on the Veterans Gold Health initiative addressing the needs of members of the military and their families while he was a medical student at The Ohio State University College of Medicine.
Dr. Dawson grew up in a military family, with his father regularly being deployed. But when he got to medical school, he was “shocked and appalled that my classmates didn’t know what a deployment was.”
The challenge was to educate healthcare professionals, so they in turn could help their patients navigate the often byzantine world of military healthcare, especially as it intersects with the often oblivious civilian world.
The best method? Just asking for help.
Dr. Dawson said they would go to people in the military and say, “Hey, we want to do this. Who knows how to do this?” And within 15 minutes, they would have a connection and an answer.
“Humanism works,” Dr. Dawson said. “It’s a lot easier just to talk to someone.”
At the end of his presentation, Dr. Dawson acknowledged the people who had helped him along the way, ending with “Thank you, Dr. Stone, for feeding me.”
Dr. Linda Stone, one of Dr. Dawson’s teachers and mentors at Ohio State, presented later that day on “Ohio Summit: Preparing the Undergraduate Humanistic Health Care Professional.”
Ohio State started a GHHS chapter in 2004. To those new to the process, Dr. Stone said, “What a journey you have ahead. You will have so many people who will care about what you do.”
Dr. Stone said that at Ohio State – and through the GHHS chapter – they strive to infuse humanism into patient care and colleague care.
“It brings us together as a family. We can share what went well and we can share what didn’t go well,” Dr. Stone said. “We can say we love you. This is a huggy group.”
A common summit theme was the idea that empathy and humanism are essential to give patients the best care – and also to care and protect colleagues and each other in a world that is often harsh.
“The U.S., which is seen to be a rich country, is poor in so many respects, particularly related to healthcare access and quality.” said Dr. Memoona Hasnain, a professor at The University of Illinois at Chicago.
Dr. Hasnain began her presentation on training healthcare workers in humanism with a story about how, as patient years ago, when she was new to this country, she was told to put on a hospital gown and go sit “half-naked” in a waiting area with both men and women – something that was in direct conflict with her Muslim faith. She was made so uncomfortable and unwelcome by this that she never went back.
That experience and others would inform not only how Dr. Hasnain would develop as a doctor, but how she would teach her future colleagues.
Sometimes the enemy is ourselves.
In a presentation on nurse-to-nurse incivility, Dr. Lina Najib Kawar, a nurse scientist at Kaiser Permanente in Southern California, spoke of how even among people drawn to a caregiving profession, bullying can predominate. This is seen by some as a “rite of passage” or “dues paying” for nurses, but it jeopardizes patient care, as well as creates a toxic workplace environment.
This human problem requires a humanistic solution, said Dr. Kawar.
“In general, all of us are judgmental,” Dr. Kawar said. “Intentionally or unintentionally, we become uncivil… we have to take people as they come to us.”
But it is not always easy to take care of one other – not to mention patients – if clinicians are feeling burned out and empty themselves.
Untreated, burnout and the resulting despair can have the most dire of consequences.
“People do not commit suicide,” said Dr. Terri Babineau, MD, FAAFP, Lynchburg Family Medicine Faculty – Big Island Rural Medicine Appalachia Clinic. “It is the result of an illness that they will die from.”
As a sign of the relevance of self-care and mindfulness, when Dr. Babineau put up slides offering practical tips – taking a breathing space, finding things to be grateful for, talking out loud to yourself in a positive way – several people rushed to take pictures of the slides.
But while self-care is important for individuals, creating a humanistic environment is bigger than any one person.
“We have to push for institutional change,” Dr. Babineau said. “Take it back to the institutions.”
The GHHS/MTL track of the Gold Humanism Summit wrapped up with a session on how to keep the flame of humanism alive in medicine. It featured Drs. Stephen Slade and Shapir Rosenberg, University of Maryland Medical Center, and focused on the importance of empathy and the threats to it.
Medical students, Dr. Slade said, “are being inducted into the Gold Humanism Honor Society at the time they are facing the forces of empathy erosion.”
One threat to empathy is, unfortunately, the process of medical education itself. Too often on the way to being doctors, medical students lose ground on being the compassionate human beings that drew them to healthcare in the first place.
“Our students are so passionate and idealistic,” said Dr. Scott Shaffer, chair of the GHHS Advisory Council. “Then they go into residency. They kind of get beaten down, and we lose them.”
We lose ground even on basic things like how to talk to people, Dr. Slade said.
“We start by having conversations and end by having interrogations,” he said. “Patients become to-do list items.”
In break-out conversations during the session, one participant noted the “lack of opportunity to have 20-to-30-minute conversations with patients about things outside their illness.”
A common theme throughout the summit was that seeing patients as whole human beings – rather than part of an increasingly long and burdensome list of tasks – is not just good for the patient, but for the healthcare practitioner as well. Truly humanistic interactions are good for everyone, and a physician or nurse struggling with long-term burnout or simply a bad day can find their patients can offer comfort and kindness just like anyone else.
And this does not have to mean losing boundaries.
“All of illness is loss… so I feel this along with my patients and their families,” said Dr. Rosenberg. “I don’t feel what they are feeling. I feel my own feelings alongside them.”
“In the end we have a lot of great resources,” said Dr. Slade, “and the most important of these is each other.”
At the end of the conference Dr. Shaffer, the GHHS chair, said he felt inspired and energized by the participants. He particularly enjoyed the comradery of chatting late into the night with a core group that stayed after the poster sessions.
“The challenge is how do we keep that going in between these meetings…. When you’re, here you feel a sense of optimism,” Dr. Shaffer said. “There’s like-minded people [and] we can all collaborate.”