The Arnold P. Gold Foundation joined with Planetree at its 40th Anniversary International Conference on Person-Centered Care, a dynamic gathering of advocates of compassionate care. Held October 7-10, 2018, the event in Boston marked the first time the Gold Foundation contributed a significant presence at Planetree’s annual conference, with sessions featuring Gold Foundation leaders, grantees and supporters. The 2018 conference laid the foundation for a 2019 conference that will be jointly hosted by Planetree and the Gold Foundation in Orlando, Florida.
“Planetree’s 40th Anniversary conference was a phenomenal event led by our sister organization, a pioneer and leader in patient-centered care,” said Dr. Richard I. Levin, President and CEO of the Gold Foundation. “We were thrilled to be a part of such an inspiring celebration and learning opportunity, and look forward to collaborating even more closely in 2019 to link our two communities.”
Celebrating the legacy of Dr. Arnold P. Gold
The 2018 Planetree conference kicked off Monday morning, Oct. 8, with a talk by Dr. Levin focusing on the legacy of Dr. Arnold P. Gold, the foundation’s namesake, and why his call to humanism is more important than ever.
The talk include a short video of Arnold’s life.
Dr. Levin then explained how Arnold’s vision of the human connection in healthcare has been increasingly challenged.
“We know, despite our 30 years, despite Planetree’s 40 years, that maintaining the human connection in our world is not easy,” said Dr. Levin during his talk. “Doctors and nurses have lost agency, have lost autonomy, in the face of the expectation and hope that big data, molecular biology, genomics, epigenetics would have the cure. And so the rest [has been pushed aside], as though the rest had been a wandering error over the 2,500 years that physicians have practiced in the West. But that’s not the case. We argue that humanism is the core of healthcare.”
Technological progress has been stunning and helped so many patients. The Gold Foundation emphasizes that care must be collaborative, compassionate and scientifically excellent. All three aspects are crucial.
Examining breakdowns in patient care
Tuesday, Oct. 9, continued with three Gold-related sessions. Dr. Kimberly A. Fisher, Assistant Professor of Medicine at University of Massachusetts Medical School, presented her research on patient perceived breakdowns in care. UMass Medical School is a member of the Gold Partners Council, a consortium of medical schools committed to advancing humanism in medicine and conveying to the healthcare professions and public the importance of Keeping Healthcare Human.
Dr. Fisher’s research finds that many times patients notice a breakdown in care but do not report it and examines the possible reasons. In one study, published in the Journal of Hospital Medicine, 39.4% of nearly 1,000 patients surveyed they had experienced at least one breakdown in care.
Who asks and what happened matters: research by Dr. Fisher and her colleagues shows that if a patient advocate inquires, patients are much more likely to say they “would definitely mention” a rude aide or slow response time than if a physician asked.
Having a family member present also makes a difference. The study found that patients said they would report a breakdown in care 38% of the time when they were alone, but 53% of the time when they were with a family member or friend.
Dr. Fisher also noted there are some simple ways to help address such breakdowns in care, and apologies can be helpful for patients who do speak up.
Read more about Dr. Fisher’s talk here.
Incorporating Tell Me More® at Quest Diagnostics
On Tuesday afternoon, the Gold Foundation and Quest Diagnostics presented a session on Tell Me More® strategies. Quest Diagnostics is a founding member of the Gold Corporate Council, an alliance of leading healthcare corporations that have come together to elevate humanism in healthcare, both within their own organizations and in the broader healthcare community. Quest Diagnostics has partnered with the Gold Foundation to implement a customized version of Tell Me More®.
Tell Me More® helps patients and caregivers to get to know each other beyond their diagnoses and job descriptions. It can be implemented in a variety of ways, including as simply – yet powerfully – as a sign on a wall in a patient room that lets the patient share a few personal details, which illuminates him or her as a person, separate from their illness.
Elizabeth N. Cleek, Chief Program Officer of the Gold Foundation, and Pia Pyne Miller, Director, Humanistic Healthcare Strategy presented how Tell Me More® is utilized in care and corporate settings to elevate connection.
Nora Branconi, Executive Director, Customer Service at Quest Diagnostics, shared how Quest has incorporated Tell Me More® into its Everyday Excellence program to encourage employees to connect with their customers. For example, a phlebotomist drawing blood from a patient might be attuned to a shift in a patient’s mood and tap into her training in Tell Me More® to ask if everything is OK.
“Tell Me More® is really about taking the best of who you are and really pushing it up just a little more to the next level,” explained Ms. Branconi. “So you have to pick up on those cues. When someone comes in and they’re edgy: “Oh, it looks like you are a little flustered today. Why?” You have to open up that door. We wanted to separate the interaction from the transaction.”
“As we gave people these tools, we wanted them to find their way back to why most people came to Quest Diagnostics: They came here because they wanted to make things better, they want to help people have a better life,” said Ms. Branconi.
Facilitating interprofessional collaboration in the opioid crisis
Finally, Tuesday’s Gold sessions were capped off with a presentation by Picker Gold GME grantee Dr. Juliette Perzhinsky, Associate Professor, Central Michigan University College of Medicine. Dr. Perzhinsky received a Picker Gold grant to support her creation and implementation of an interprofessonal training designed to optimize mental health care for patients managing chronic pain with opioids. She shared her learnings so far in this important work. Dr. Perzhinsky was also a 2017 Gold Humanism Scholar at the Harvard Macy Institute for Program for Educators in the Health Professions.
“This is an important topic to discuss,” Dr. Perzhinsky began her talk, “because when we try to think about the opioid crisis, this is not just going to be a physician issue. This is an issue that impacts the entire healthcare team. It’s very evident that we don’t have the set-up for that in Graduate Medical Education yet.”
As a clinician, Dr. Perzhinsky was caring for patients who were managing chronic pain with opioids and noticing that many had underlying or undiagnosed mental health conditions.
She pointed to statistics that show 25% of patients have a mental health condition – over 43 million. “Further complicating that is that 50% of U.S. adults will actually develop a mental health condition in their lifetime,” she explained.
Through this initiative, Dr. Perzhinsky is helping trainees work collaboratively across professions and with patients to better care for and understand the complexities that are involved in chronic pain management, particularly as it is co-morbid with mental health conditions, such as depression or anxiety.
With the funds from the Gold Foundation’s Picker Gold grant, Dr. Perzhinsky and her team developed five interactive sessions of interprofessional trainings, along with pre- and post-curriculum assessments.
Designing a medical school for the 21st century
Wednesday started bright and early with a talk at 8 a.m. on “Starting a New Medical School: How We Focus on Teaching Empathy, Communication and Self-Reflection” by Dr. Lawrence Smith, Founding Dean of the Zucker School of Medicine at Hofstra/Northwell and Executive Vice President and Physician-In-Chief, Northwell Health. Dr. Smith is also a Board member of the Gold Foundation.
Dr. Smith envisioned a radically different structure to the new Zucker Medical School, which opened in 2011. In studying how to create a curriculum in the 21st century, they learned that there was almost no retention two years later from what was taught in the first two years of medical school.
“We decided that this device had made memorizing things obsolete,” explained Dr. Smith, holding up his cell phone.
“We designed – with the help of many, many scientists and clinical specialists – a curriculum that never required memorizing anything, but demanded that you understood the concepts of science at a sophisticated enough level that when you saw a patient, you would apply those principles to solve the patient’s problems. And you could do that on your own, with coaching from faculty, but not with teaching from faculty,” he explained.
The principle of the Zucker School of Medicine is clear and simple: “The only measure of a great physician is if they are effective,” said Dr. Smith. “Not if they’re smart. Not if they know a lot of stuff. Not if they’re nice. It’s only if they can create an effect in the patient that the patient needs. And if you can’t do that, you’re a flop, no matter how smart you are.”
It requires that you take the scientific basis of health and disease and put it into action as oppose to just know it. And you have to be able to build a relationship of trust in order to collaborate with that patient and have them ever trust you to do anything that you suggest might be appropriate for their health.
And if you don’t do both of these things, you will never truly create a great physician.”
This groundbreaking approach to medical training begins at Zucker School of Medicine in the very first weeks, when students go through a course to become certified Emergency Medical Technicians (EMTs). This unique experience transforms them from bystanders to active participants, and places them in real situations that demands teamwork and gives them appreciation of the many roles of healthcare professionals involved in patient care.
Throughout Dr. Smith’s talk, in which he delved into the curriculum over four years, the design of the new medical school building, the enthusiasm of the faculty, and the dynamic collaboration with the hospital system, and much more, the audience was transfixed. As one audience member said during the question and discussion period, “I never thought I’d be so inspired by a medical curriculum!”
This inspiring work and focus on caring for the patient continued with a final Gold session on Wednesday afternoon, by Dr. Dinali Fernando.
Caring for the hidden population of torture survivors
Dr. Fernando is the Medical Director of Libertas Center for Human Rights, Elmhurst Hospital Center; Attending Physician, Department of Emergency Medicine, Elmhurst Hospital Center; and Assistant Professor, Icahn School of Medicine at Mount Sinai.
Based in Queens, New York, the Libertas Center provides medical, psychological, social and legal services to meet the complex needs of patients who were tortured in their home countries and are seeking refuge in the U.S.
Under Dr. Fernando’s leadership, the Libertas Center has grown from a volunteer program to a multi-disciplinary treatment center and national leader for this underserved population. In recognition of her ground-breaking work, the Gold Foundation awarded Dr. Fernando the 2018 Pearl Birnbaum Hurwitz Humanism in Healthcare Award.
At the Planetree conference, Dr. Dinali Fernando led a session on the hidden population of torture survivors in the U.S. and their particular care needs. Her presentation was wide-ranging, and included concrete details on how healthcare professionals can care for this population as well as guidance on the organizational level around outside collaboration, worker safety and well-being, and best practices for follow-up.
She underscored that this population has special health needs and requires holistic care to help them feel healthy, safe and whole again.
Dr. Fernando shared recommendations for an initial meeting with a patient who has such a background, including assessing their current support systems, needs in all domains of care (medical, mental health, legal and social services), and what they view as their most urgent needs.
She advocates a patient-centered approach, and one of the core aspects is the sense of safety. “The first thing you have to do is build trust,” Dr. Fernando emphasized. “The history that they are giving you is a very difficult history for them to share. So they have to feel, know and understand that they are in a safe space. That’s really number one.”
“You want to take a strengths-based approach,” she advised. “These clients have had their dignity stripped from away from them. They have so many strengths that you want them to recognize; strengths that they probably haven’t acknowledged in a really long time. The goal is to get them to use their own strengths to solve their problems, and move forward in their process of recovery.”
“You want to empower them and give them back a sense of self-control so they can be involved in their treatment plan : What are the most important aspects of my care? Who do I want to be a part of my care team? What are my goals and how am I going to get there?”
Dr. Fernando also shared general principles to help elicit a patient’s history. If a healthcare professional notices scars during a physical exam, that offers an opening to learn more. “If you ask them, they will tell you, but you have to take the time to ask them,” she said.
She emphasized that recounting the events of abuse can be very stressful and potentially re-traumatizing for the patient, as well as difficult for the interviewer to hear. “You have to know when to nudge them to open up to facilitate their healing, but be gentle. The whole process takes time,” she said, adding that patients may get dates and times confused, but that this is not uncommon. Patients may have had traumatic brain injuries or PTSD which can affect their memory and concentration.
She also advised special care in any physical examination: to begin with the less intrusive elements, to avoid prolonged nakedness, and to explain each step.
Alternative therapies such as photography, dance or art, can also provide benefits, allowing patients to express themselves in novel ways and rediscover their voice.
Through all of its work, which also includes legal and social services, the Libertas Center has seen measurable improvement among its clients. And more than 90% of clients with an affidavit provided by the Libertas Center experienced a positive outcome in their immigration case.
Dr. Fernando closed with a statement from a Libertas client, a woman from Asia who was severely persecuted: “The Libertas Center opened a window of opportunity and hope. Now I have my green card and am working as a lead teacher in a school in NYC. I want to settle down with my daughters and assist them to follow my pathway to a successful life; I want to show my daughters how to be strong and fight for their rights.”
Read more about Dr. Fernando’s work.
Honoring Dr. Fernando, recipient of the 2018 Pearl Birnbaum Hurwitz Humanism in Healthcare Award
On Wednesday evening, the Gold Foundation hosted a special reception to honor Dr. Fernando and her important work at the Libertas Center for Human Rights. It was attended by Dr. Ron Arky, a Harvard professor whose generous support and enthusiasm led to the creation of the award; Dr. Sandra Gold, Board member and co-founder of the Gold Foundation; Jonathan Seelig, grandson of Pearl Birnbaum Hurwitz; Ed Burleson of Henry Schein, a Gold Corporate Council member, and many other healthcare leaders and supporters.
The conference closed with a remarkable awards ceremony that honored the many hospitals and medical centers who have worked to become Planetree certified or participated in another noteworthy way. At the ceremony, Dr. Levin officially presented the 2018 Pearl Birnbaum Hurwitz Humanism in Healthcare Award to Dr. Fernando.
Please join us next year as Planetree and the Gold Foundation join forces in a remarkable conference in late October 2019 in Orlando. More details will be forthcoming in early 2019.