What are the habits of highly humanistic physicians?

by Carol M. Chou, MD

Most physicians would probably agree that a humanistic approach to patients– one that is sensitive to the cultural backgrounds, values, and preferences of the patient–is essential for quality patient care.

However, time and financial pressures, as well as productivity and academic demands, can dilute our best intentions, and the ideals with which we entered medicine can become compromised over time.  This can in turn lead to a snowball effect: if doctors themselves are having a hard time feeling humanistic, it can be hard to model humanistic attitudes to their learners.

To address this phenomenon, we conducted a study, entitled Attitudes and Habits of Highly Humanistic Physicians, that was published July 2014 in Academic Medicine.   We wanted to know if there were any attitudes, habits, or other factors that might help physicians to sustain humanistic behaviors over time.  We were also interested in whether these identified factors might in turn be teachable to learners, thus perpetuating humanistic behaviors in the medical profession.

We wanted to learn from the most humanistic of physicians.  Because resident trainees work closely with attending physicians and see them in action with patients, we  surveyed internal medicine residents at the University of Pennsylvania to find out which attending physicians they identified as role models for humanistic patient care.  We then interviewed the physicians at the top of that list to discern, from their point of view, how they maintain their humanistic attitudes.  Here are some highlights from those interviews.

Attitudes of these humanistic physicians include:

• Approaching patients with a sense of humility and real curiosity about their lives, especially toward those patients to whom it may seem difficult to relate
• Treating their patients as they themselves would wish to be treated
• Seeing their role as not merely taking care of the medical aspect of their patients, but also helping their patients through life struggles– ‘being there with and for the patient.”

Physicians were able to identify habits they practice to actively sustain their humanism:

• Ongoing and active self-reflection (specifically, reflecting on ways to be more compassionate toward patients)
• Being in a teaching role, where learners stimulate the physician and remind them to uphold the standard of humanism
• Practicing mindfulness and other spiritual practices

Two of the most significant habits include:

1. Seeking a connection with patients.  The very connection with patients that these physicians work to forge in and of itself sustains their humanism. Finding a meaningful connection with patients was cited as not only benefiting the patient, but also having the dual benefit of helping to prevent burnout in the physicians themselves.
2. Achieving balance.  As expected, work-life balance (taking time outside of work for renewing activities such as reading, exercise, and family) was cited by many physicians in our study as important in maintaining their humanism at work.  An interesting twist to this theme was that work-work balance –in other words, a diversity of duties at the workplace– also allowed many of these physicians to maintain their humanistic attitudes.

Looking for ways to achieve a balance of duties on the job, seeking renewal from the stimulation of teaching learners, and making meaningful connections with patients during direct patient care are some examples of finding meaning in one’s work.  Transforming work from a place of energy expenditure to one of energy renewal may be one reason why these habits seem to provide an antidote to burnout.

That these physicians deliberately practice habits which focus on maintaining and improving their humanism reassuringly runs counter to the oft-expressed belief that humanistic attitudes are innate.  Rather, the fact that the habits identified by these physicians can be modeled and taught to learners is promising for the sustainability of humanistic practices in the medical profession.  Even more exciting is the link between the humanistic care of patients and the perceived outcome of reducing burnout in physicians themselves, which should provide even more incentive and inspiration to foster the teaching of humanism in the workplace.

Carol M. Chou, MD is a general internist and associate professor of clinical medicine at the University of Pennsylvania.  She is the first recipient of the Williams fellowship at Penn, which funded this study.  She also is a member of the American Academy on Communication in Healthcare (AACH) and recently completed AACH’s facilitator-in-training program.