The Bellevue Association honored Dr. Lewis Goldfrank on Oct. 2, 2019, for his pioneering impact on emergency medicine and great work as a humanist and physician.
When Dr. Lewis Goldfrank was a medical student, he was pointed to the emergency room and told to just “go sew someone up.” That was the extent of the guidance.
The lack of humanity appalled the young med student. The directive showed a dismissiveness about the people looking for help. They were just bodies in need of stitches and it did not particularly matter how or why.
This was one seed that led to the growth of a medical humanist who decades later would be saying to new doctors that good, effective medicine means “putting the human before anything else.”
Dr. Goldfrank is the Herbert W. Adams Professor of the Ronald O. Perelman Department of Emergency Medicine at NYU-Langone Health Center and Bellevue Hospital Center. Dr. Goldfrank was recently honored by the Bellevue Association for a distinguished career spanning more than 40 years in medicine, including being a pioneer in the emergency medicine field. The Bellevue Association is a public/private partnership that supports Bellevue Hospital Center’s inclusive healthcare, so that every person in need will be receive humanistic care.
Dr. Richard Levin, President and CEO of The Arnold P. Gold Foundation, worked with Dr. Goldfrank in their long careers at NYU. Now Emeritus Professor of Medicine at NYU, Dr. Levin served as Vice Dean for Education, Faculty and Academic Affairs and was a cardiologist and faculty member for many years.
“Lewis embodies humanism and all that the Gold Foundation stands for. His philosophy and high standards – Gold Standards, we would say – made the NYU Department of Medicine legendary in the modern area, just as Bellevue, the oldest hospital in America, has been famous for more years than the country has existed,” said Dr. Levin.
Many leaders from across NYU and the New York City healthcare community came out to honor Dr. Goldfrank, including NYU Langone Health CEO and NYU School of Medicine Dean Robert Grossman and NYU Langone Health Chairman Kenneth Langone. NYU School of Medicine and NYU Medical Center are also Gold Partners Council members at the Hippocrates (highest) level, indicating their strong support of the Gold Foundation and the mission of humanism in healthcare.
The Bellevue Association celebration on October 2, 2019, was also a fundraiser for Project Healthcare, a program started by Dr. Goldfrank in 1981 to train college students to be patient advocates as part of the emergency room team. Their primary function is to sit with patients, listen to their stories, and do what is necessary to give comfort.
Project Healthcare is meant to “bridge the gap between just knowing a lot of facts and humanism,” Dr. Goldfrank said. Many of the students go on to become doctors who understand from experience that humanism is at the core of the best healthcare.
In an interview, Dr. Goldfrank said that what he looks for in new residents in emergency medicine is not just intelligence or technical know-how. He is looking for optimists who are always listening, always learning, and who are committed to solving human problems.
“They have to be the best people,” Dr. Goldfrank said. “They have to be prepared to function with any human, to be devoted to that person’s human rights… I need people who believe they can change the world.”
And they have to be ready to deliver slow medicine as well as fast.
Fast medicine – where you have to pull out all the stops to keep the heart beating before you may be able to make a human connection – is needed to save someone who is in imminent danger of dying.
But for most people walking through the emergency room door, it is slow medicine, the human connection, that will be the most effective and healing in the long run. It is knowing when someone’s chest pain is due to a heart attack or “because they haven’t seen their child in years because they are undocumented.”
Doctors who are good at slow medicine, Dr. Goldfrank said, understand that often the story patients “told you was not really the real story because they didn’t know how to express it or we didn’t know how to listen to it.”
At Bellevue, listening to find the real story that can lead to healing can be complicated. For one thing, Bellevue’s patient base includes people who speak 150 languages so sometimes clinicians and patients will literally not speak the same language. Other patients don’t understand how the healthcare system works or what their rights are.
The emergency department doctor has to help patients deal with all of those things and be ready for vastly different challenges. One moment you are dealing with someone who has a stab wound, the next someone who has come in because they are lonely.
The job is to figure out how to help the patients solve the problems that brought them in.
Dr. Goldfrank gave the example of a woman who had been seen a few times after feeling chest pain. The theory was there must be something wrong with her heart, but so far the diagnostic tests had failed to find what that was.
The woman was with her young daughter. She spoke only Spanish, and Dr. Goldfrank communicated with her with the help of a telephone interpreter, which sometimes is enough to get over the language barrier. But, in this case, he sensed it wasn’t.
Dr. Goldfrank asked one of his colleagues who spoke Spanish and who was about the same age as the patient to see if she could understand better what was going on.
In the meantime, Dr. Goldfrank looked through the patient’s record and noticed that when she came with chest pain it was on a Tuesday. This latest visit was also on a Tuesday.
So Dr. Goldfrank asked his colleague to find out what the patient did on Tuesdays.
It turned out that every Tuesday morning the patient spoke with her mother in Guatemala, whom she had not seen in many years – so long that the patient’s mother had never even met her granddaughter.
The patient would talk with her mother on Tuesdays and cry. And get chest pains.
“Your soul is hurt, and you feel heartbroken,” Dr. Goldfrank said to his patient. But her physical heart – the worry that had brought her to the ER — was fine.
It was a different problem to help the patient solve – and one that would not be solved if by just looking at ventricles and arteries or thinking only in terms of tests and pills and procedures.
“Not everyone needs a technical task,” Dr. Goldfrank said.
But everyone needs compassion and connection. A far cry from “go sew someone up.”
“Every day you find people you can help and do good for, if you have that commitment,” Dr. Goldfrank said. Even working “all day long with critically ill and injured people you still get great smiles… and can help them just feel a little better.”