The inaugural Gold Humanism Summit was a study in partnership. Even the conference itself was done in partnership with Planetree International, with the Gold Foundation and Planetree events open to each other’s participants.
“We’re thrilled to be your co-conspirators this year,” said Gold Foundation’s CEO and President Dr. Richard Levin during the Planetree conference’s opening ceremony. Defining humanism, Dr. Levin noted, “The best care is compassionate, collaborative, and scientifically excellent – it must be all three.”
To that end, the General Session of the Gold Humanism Summit featured research and presenters that demonstrated the importance of infusing the healthcare spectrum with humanism – which itself should be a natural partnership but so often is not in this world that prizes technology to the point of disconnection.
Human connection, literally a simple “I’m here,” helped saved the life of Marcus Engel when he was an 18-year-old car accident victim.
Mr. Engel, the morning keynote speaker at the summit, is an author and adjunct professor at the Hillebrand Center for Compassionate Care in Medicine at the University of Notre Dame. He recalled waking up, at age 18, after a drunk driver slammed into the car he and his friends were in after returning from a hockey game.
“I was lying face down in the street,” Mr. Engel said. “Spitting out teeth… gasping for air.”
“Hold my hand, Marcus,” Mr. Engel would hear through the pain whenever he woke up in the emergency room. “My name is Jennifer. You are in the hospital. You were in a car accident.”
And then the most important two words of all.
Inspired by those two words and the compassion behind them, Mr. Engel would eventually start the I’m Here Movement committed to compassionate patient care. But, for 20 years, this is all that Engel would know about Jennifer. Some friends even wondered if he imagined her, his subconscious knowing that what he most needed was to hold someone’s hand and hear “I’m here.”
It turned out that Jennifer was very real. They would find each other by happenstance. Engel was speaking about the I’m Here Movement. A colleague of Jennifer’s attended the event and asked if she happened to go. When Jennifer heard the story she said, “That was me.”
In their reunion video posted on Mr. Engel’s website, Jennifer told of how she never forgot him either and never stopped holding his hand until he was transferred to the ICU from the emergency room where she worked as a tech when she was 20.
So it turned out Jennifer – now a Chief critical care nurse – was real, as was the lesson she taught Engel all those years ago about the importance of presence in patient care.
“This idea of being present,” Mr. Engel said, “We forget there is another human being at the end of the stethoscope.”
Other sessions focused on strategies to create that connection – from a session on recognizing, understanding, and addressing implicit as well as unconscious bias and communication across cultures presented by Judy Ravin, President, Accents International, and Dr. Ruth Shim, Director of Cultural Psychiatry at UC Davis, to a session focused on enhancing cross-disciplinary and interprofessional communication, presented by Dr. Ellen Friedman, Director, Center for Professionalism in Medicine, Baylor College of Medicine, and Dr. Jordan Shapiro, also of the center – highlighting a curriculum which emphasizes communication among teams.
They noted that while a focus on kindness in patient care is prevalent, we frequently overlook the importance of treating others on the clinical team with kindness. They highlighted a video based curriculum, available through the Center, which serves as a springboard for discussion around ways to improve understanding and kindness among members of the health care team – called The Threads Among Us. Dr. Sandra Gold, Co-Founder of the Gold Foundation, introduced the session and also held a separate session, sharing the touchstone story of her husband, The Legacy of Arnold P. Gold and the importance of humanism in teaching, communicating, and clinical practice.
Strategies for “applying humanism in practice” were abundant, and continued when Dr. Alice Fornari, Vice President of Faculty Development at Northwell Health and Dr. Taranjeet Ahuja, Clinical Experience Director and Assistant Professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell presented a session by that title, as well as a poster. The two have closely collaborated with the Gold Foundation frequently, and presented on two strategies they’ve implemented – Tell Me More® (described below) and MAP-IT (Mentoring and Professionalism In Training), developed by Dr. Fornari with Gold Foundation support, which she has grown and implemented throughout the Northwell Hospital system.
The specter of burn-out in part fuels such programs because, as Fornari says, “burn-out makes it nearly impossible to give compassionate care.” But MAP-IT “is not a remediation program. The program gathers together mixed groups of healthcare professionals for monthly reflective sessions. It is an enhancement program” for “high potential leaders,” Dr. Fornari said.
While the MAP-IT program focuses on supporting healthcare practitioners, the Tell Me More® communication program, whose implementation and success was also referenced at the Gold Executive Leadership Track, focuses on patient stories of who they are and what’s important to them, so their healthcare providers don’t as Mr. Engel would say, forget there is a human being “at the other end of the stethoscope.”
Tell Me More® is a program licensed through the Gold Foundation that asks patients to fill out posters or cards telling their healthcare providers who they are as people, separate from their reason for being in front of a healthcare practitioner as a patient.
A patient “in a gown, half-naked, that’s not the person they are,” said Dr. Ahuja.
The posters are meant to help answer the question “who is this person?” and help busy clinicians make instant connections with their patients. Dr. Ahuja showed the poster of pediatric patient who, in her life outside the hospital, was class president and had the motto “Kindness is the new beautiful.”
Seeing the motto, Dr. Ahuja, whose training is in pediatrics, knew “that’s my girl!”
The Tell Me More® program, Dr. Ahuja said, reminds patients that “they are unique and have strengths in the most vulnerable time of their life.”
In a separate session, Garry Clark, Executive Director, Marketing Services at Quest Diagnostics, discussed Quest Diagnostics’ implementation of Tell Me More® through its Everyday Excellence program.
Other strategies included “Flourishing at Work: Transforming Healthcare Through Mindful Practice” presented by Dr. Ron Epstein. Mindful practice refers to cultivating qualities of mind during every day practice that promote self-awareness, attentiveness, curiosity, flexibility and presence in the service of improving the quality of care they provide, resilience, and a sense of connection with their work. Mindful clinicians experience lower burnout, provide higher quality care, form stronger relationships with patients, listen more effectively, are more empathic, and are less subject to cognitive and implicit bias. The Gold Foundation is thrilled to be collaborating with Dr. Epstein and his colleague Dr. Mick Krasner to make this “transformative” “flourishing” “thriving” workshop more widely accessible. Along with Dr. Epstein’s session, Ben Rodriguez, the Gold Foundation’s Chief Financial and Administrative Officer, introduced separate informative video sessions about the Mindful Practice™ workshops.
Two partners of the Gold Foundation, the Alda Center for Communicating Science were also present. Dr. Susmita Pati and Lydia Franco-Hodges facilitated an experiential workshop using improvisational methods to foster communication and Dr. David Fryburg presented a novel program to uplift providers and patients – EnSpire™.
The summit included a panel discussion about “hidden populations,” people whose whole lives – and not just their moments in an exam room – might feel vulnerable and marginalized.
People who make up hidden populations – often survivors of discrimination, abuse, or trauma – carry extra burdens with them into their healthcare visits. Speaking about victims of human trafficking, Deb O’Hara Rusckowski, a Gold Foundation Board Member, Founder of Nurses with Global Impact, Delegate for the United Nations for the Sovereign Military Order of Malta, and one of the founders of the Global Strategic Operatives to Eradicate Human Trafficking, Inc., serving as “Ignitor” to fan the flame and take the conversation to the next level – noted that “hidden populations” are often “hidden” in plain sight. The job of healthcare providers is to create a safe space and opportunities to identify, treat, and respond appropriately to people who are being, or are at risk of being victims of human trafficking.
“The way [patients] are or are not interacting can be directly related to their trauma,” Dr. Dinali Fernando said during the panel discussion at the summit. Dr. Fernando is an ER doctor and the Executive Director of the Libertas Center for Human Rights. She was also named the 2018 winner of the Gold Foundation’s Pearl Birnbaum Hurwitz for Humanism in Healthcare Award. Dr. Fernando in particular works with refugees, asylum seekers and survivors of torture. People “who go through very dangerous journeys to get here,” she said.
“One of the purposes of torture is to kill an individual without really killing them, to take away their power,” Fernando said. So the focus for the health care for torture survivors has to be giving them back their power. “It’s so important to empower,” Dr. Fernando said.
After 911, fire fighters in New York City were everywhere, lauded as the heroes they were in the wake of disaster. So, it might not seem like they would belong in a discussion of hidden populations, said Dr. Kevin Kelly, Clinical Professor of Psychiatry and of Professional Ethics in Medicine at Weill Cornell Medicine.
“They were hidden with respect to mental health care,” Dr. Kelly said.
The fire fighters had been through “seriously traumatic” experiences but the culture of the firehouse and of the predominantly Irish and Italian homes they grew up in meant that they were loath to talk about this. So, they suffered in silence and felt like there must be something wrong with them for suffering at all.
“I know, but he doesn’t know, that the guy next to him and the guy next to him and the guy next to him are going through the same thing,” Dr. Kelly said.
A mistake well-meaning mental health counselors made in the wake of 911 was to push the firefighters to talk about their feelings, to assure them this was all right. But to the fire fighters it wasn’t all right and the attempted interventions felt like intrusions from a world that didn’t understand them.
To find a way in to give the fire fighters relief, said Dr. Kelly, you have to become part of “the tribe,” said Kelly who is also now the FDNY Medical Officer. “Establish the fact that you are a regular person that they can talk to… it’s particularly helpful if you can talk about Notre Dame football, which fortunately I can,” Dr. Kelly joked.
Once you establish that hard-won trust – which can take a long time – you can start to “influence them to come to you, but not push too hard.” And once they come to you might describe what they are going through. That people who have been through similar things for example might feel unaccountably angry and take it out on their loved ones.
“It’s not something you want to do, but you can’t help it,” Dr. Kelly would say to them about the anger. He would see nods of recognition. This process would spark a realization in the firefighters. If a doctor who didn’t know them very well could describe what they were going through down to a T, if he could point out dead-on descriptions of it in psychology books written by people who didn’t know them at all, then maybe their suffering wasn’t weird or a sign of weakness. It was a normal reaction to a terrible trauma.“And there is the possibility of treatment,” Dr. Kelly said. And of hope.
From reaching patients trapped in trauma, the summit moved onto sessions on storytelling and its power to heal not only patients, but their caregivers.
“Life gets real at the bedside…there’s no time for noise or diversion,” said Michael Vitez, a Pulitzer prize-winning journalist who pulled triple duty at the General Session as a panelist for “hidden populations”, participating in the poetry/writing “slam”, and bantering session on “Narrative Medicine”. Mr. Vitez developed the Narrative Medicine program at Temple University, where the mission is “building a culture of stories. Our brains are wired for stories.”
The stories are not just those of patients. Storytelling can be vital for healthcare professionals as well.
“We have to care about the stories of our students and the stories of our colleagues,” said Dr. Hedy Wald, a prolific writer and writing teacher, as well as a Clinical Professor of Family Medicine at Brown University and on the faculty of the Harvard School Global Pediatrics Leadership Program.
“I’m convinced this leads to better patient care,” said Dr. Susan Ball, Professor of Clinical Medicine at Weill Cornell Medical College, who recently published a book about her experiences treating patients with AIDS and HIV since the early 1990s. Ball was part of a panel on a new film called “Why Doctors Write” produced by Ken Browne, who also served as “Ignitor” for this panel session.
“This film basically began because someone told me about the Arnold P. Gold Foundation,” which l’d him to read doctors’ stories, Mr. Browne said.
Part of teaching healthcare professionals how to share their stories is removing the barriers to writing that many people have, said Dr. Deepthiman Gowda, Assistant Dean for Medical Education at the new Kaiser Permanente School of Medicine where he has led the effort to start a narrative medicine division.
Even when you’re an accomplished doctor, writing can be intimidating for some.
Dr. Amy Ship, Director of Atrius Health, Brigham and Women’s Hospital, only really engaged with poetry starting 10-15 years ago. “Before that, it actually scared me,” Ship said.
Poetry now provides an “easy way in” for Dr. Ship. “I bring it to pretty much everything I do,” she said. “It changes the space in the room.”
“I think being a poet helps me tremendously in my work as an anesthesiologist,” said Dr. Audrey Shafer, Director of the Stanford Medicine and the Muse Program. Dr. Shafer provides extra breaks for her residents for writing with “no expectation that I will be reviewing everything… A number of our graduates were like seeds who started programs in their residencies and beyond,” Dr. Shafer.
All of the panelists in the film, along with Mr. Vitez and Dr. Wald, also participated in a lively and well-received poetry/writing “slam” sharing excerpts from their bodies of work. Mr. Browne also introduced a second session where he told the wonderful backstory behind the film as well as a short screening or “sizzler” of the film.
Along with Mr. Rodriguez’ introduction of the Mindful Practice™ sessions, there were two other sessions facilitated by members of the Gold Foundation to highlight best practices and programs.
Louisa Tvito, MSW, Director of Program Initiatives and the Assistant Director of the Gold Humanism Honor Society (GHHS) presented a variety of Golden Glimmers. The Golden Glimmer project began as a way for GHHS members to express themselves in creatively, while also connecting them to one another. To date, the GHHS staff have launched four different calls for Golden Glimmers: Advice for medical students in the form of Haiku, photos that elicit feelings of joy, resilience, or passion, photos that made our members SHINE in the summer of 2019, and a call to restore joy in medicine through poetry! The submissions have been incredibly touching, and act as a tool to bond medical students, residents, and practicing doctors within the Gold Humanism Honor Society and beyond.
And Pia Pyne Miller, Senior Director for Strategy and Business Development at the Gold Foundation introduced a webinar video done in collaboration with the Penn State Health Physician Writers Group. Ms. Miller has been looking and listening for best practices amongst Gold Partners Council members, and those are then shared through various channels. She said, “We are here showcasing humanism in healthcare innovations, techniques and programs, that should transcend the institution they are at so they can be studied, brought, and replicated to our other partners because they represent best practices and speak directly to our mission at the Gold Foundation.” Highlights from this innovation, the Writers Group created by Dr. Kimberly Myers, featured physician writers sharing their work. Dr. Elizabeth Cleek, Chief Operating Officer and Senior Vice President at the Gold Foundation, and Ms. Miller spoke with the writers in groups to understand the program’s impact and conducted a conversational interview with Dr. Myers to understand the impetus behind the program. Additionally, Dr. Myers shared best practices that can be considered by those hoping to replicate the program.
The General Session of the Gold Humanism Summit highlighted many strategies to foster humanism in the work environment.
Dr. Donald Brady, Senior Associate Dean for Graduate Medical Education at Vanderbilt University Medical Center, spoke of the “intertwined needs of patients, systems, and healthcare professionals.”
In 2017, Vanderbilt was one of winners of the ACGME – Gold Foundation DeWitt (Bud) C. Baldwin, Jr. award recognizing health systems that demonstrate excellent humanistic practices throughout their hospital system, and particularly with regard to the medical education environment. Dr. Elizabeth Cleek participated in the site visit to Vanderbilt for the award selection and “was blown away by the work they are doing there.” For Dr. Brady, the complex world of a healthcare system comes down to one simple thing.
“It’s about the people,” he said.
This was brought home to him when a close colleague recently died suddenly and unexpectedly. “It just brought back the humanity of what we do,” Dr. Brady said in dedicating the session to his friend’s memory. “We never know how long we will be here.”
Dr. Brady said part of patient care is seeing things from the patient’s perspective.
“What to us is routine, to the patient it’s life and death,” Dr. Brady said. “What to us is the clinical environment, to the patient is their life.” And, as it is for patients, it is important to realize that staff and residents are people too.
Dr. Brady described how when a spider sees an injury to its web it immediately goes to the weak spot and reinforces, double-threading, so it is even stronger than it was before the injury.
As a human example of this, Dr. Brady offered the story of a young doctor who had become so sick with nausea that she had needed to take a year off from her fellowship.
Not only did Vanderbilt protect her fellowship during that year, when she came to them with an idea to study nausea in the interim – because she now knew more than most what many of her patients suffered – they supported that as well. Using her research, that fellow went on to create a program at Vanderbilt serving children with chronic nausea – making the institution stronger in the process. “Because of the kindness of her mentors she was able to take her experience for what she could do for her patients,” Dr. Brady said.
Another wonderful partner of the Gold Foundation is “Patient Lee” Tomlinson, Founder and Chief Inspiration Officer of the C.A.R.E. Effect Movement. Mr. Tomlinson also pulled double duty by delivering his keynote at both the Planetree Conference and the Gold Humanism Summit. A seasoned and much sought-after speaker, Mr. Tomlinson’s mission is to inspire healthcare professionals to bring compassionate C.A.R.E back to the forefront of modern medicine, not because it is a nice thing to do but because it is the right thing to do to improve outcomes. He is currently collaborating with the Gold Foundation on thought leadership and together are developing the “Kindness Challenge”.
Keynote speaker Dr. Paul DeChant, Deputy Chief Health Officer at IBM Watson Health, argued for conscious redesign of toxic healthcare environments that includes doctors and nurses in the process.
“Every interaction is an opportunity for healing,” Dr. DeChant said.
Dr. DeChant said that there all kinds of pressures on healthcare professionals many of which – like work overload, community breakdown, loss of control – drive rampant burnout not just among doctors and nurses, but healthcare administrators as well. “We have added the last straw…and people are breaking,” Dr. DeChant said. “It can’t be fixed by simply telling people to do more because there is no capacity to do more on an individual basis.”
Dr. DeChant gave an example of a doctor who had been suffering burnout and was considering quitting. But who after his work environment was redesigned felt like he had gotten his own life and health back. The kicker: the doctor thought that while his work-life balance had markedly improved and he was happier, he thought probably it was at the expense of his productivity.
“He was actually up in productivity,” Dr. DeChant said.
After an informative presentation, Dr. DeChant left the participants with this.
“My question to you is, ‘What will you do next week?’”
Dr. Rich Levin reiterated that point by deputizing attendees as “Gold Ambassadors,” and challenged all in attendance to further humanism and humanistic practice, amplifying the work of the Gold Foundation.