Teaching Humanism in the New Era of Medicine

I never thought I was going to be the attending who started off a sentence with “when I was a student/resident…”  But one day, I realized, I had become that person.  It was not to prove that I worked harder checking labs or rounding on my patients.  It was in a different context.  I was telling my medical student about an experience I had when I was a student myself that had helped to shape the surgeon I had become.  As part of our graduation requirement, we had to spend an afternoon a week for half a semester in the home of a patient interviewing them, learning about their medical problems, and how they interfaced with the health care system.  I was paired with a middle-aged woman who lived in an economically poor urban area.  Once a week, I would drive to her house and spend an hour talking to her.  She was morbidly obese and spent much of her day in a recliner with her oxygen tank.

I grew up in a white collar town in New Jersey with two PhD educated parents and had the privilege of going to a private university and medical school.  My days with her were eye-opening and what I learned from her, taught me more than a textbook could ever explain about what a patient needs when they are sick.  I will call her Christine.  Christine grew up in a working class area of Rhode Island.  She married when she was young.  Her first husband used to physically abuse her and the child they shared together.  He burned the child on the stove and was eventually incarcerated.  Christine moved on to her next abusive relationship.  Her next partner whom she had children with did not abuse her but molested her children.  She did not find out until several years into the abuse because she was working long hours to pay her bills.  She eventually exited that relationship as well.  Feeling broken, Christine began to spiral into depression, eating more than she should, smoking cigarettes.  She eventually became morbidly obese, diabetic and had COPD.  When I met her she was living alone living on disability.  She relied on a van service to take her to her appointments.  Sometimes it came, sometimes it did not.  When it did, it was usually late.  She had no one to talk to except for the occasional neighbor who stopped by or a child who dropped some groceries off at her house.

During those few months, I was her company, something she looked forward to every week.  I mostly sat, listened, took notes.  I learned that health care for some people was not as easy as displaying your insurance card, filling your prescription, taking your pills, doing what your physician told you, getting better.  It is fraught with not only physical but social and emotional barriers that can prevent a patient from healing.  I could not imagine standing in her shoes and remembering to check one’s blood sugar and dose the proper insulin.  At the end of our time together, she thanked me.  I asked her “For what?”  She said, “I have terrible self-esteem.  And knowing that I have helped you learn in some way has made me feel like I have some purpose.”  I always think of Christine when I run into a “difficult” patient with a student.  Many of my patients have cancer and my students and I will talk about the challenges one may have socioeconomically that make things harder for them than other patients which may make them non-compliant with treatment.  Or with patients who may be fiscally well off but still have difficulties with their diagnosis, lashing out in the office because they are scared of their diagnosis.  These are the times I tell them that compassion, listening, means the most.

The Arnold P. Gold Foundation defines humanism in healthcare as the following:

Humanism in healthcare is characterized by a respectful and compassionate relationship between physicians, as well as all other members of the healthcare team, and their patients. It reflects attitudes and behaviors that are sensitive to the values and the cultural and ethnic backgrounds of others.[1]

While teaching our students and residents the latest treatments, surgical techniques, cutting edge science and novel drugs is important for the treatment of our patients, it is also important that we do not forget to teach them the other half of doctoring that means the most to patients- humanism.  It entails not only compassion, but respect and empathy.  These are the things we should do and remind ourselves of when we are tired and burned out or buried in a journal and scouring the internet for answers.

1. It is our job to show our trainees that in addition to our clinical expertise, we do not forget that there is a scared, sick, individual who could be our mothers, our cousins, our brothers and it is our job to improve their lives as best as we can while respecting their choices.
2. I always tell my students that it is an honor and a privilege to be a surgeon and that people share things with us (their stories, their gallbladders, their tumors) that they do not even share with their most intimate partners.
3. Sometimes you need to take an extra minute and be late for the next patient if the patient you are with now needs you in that moment. I always apologize to the next patient and explain that I will extend that extra time to them if they need it as well.
4. We should not judge. If a patient has ideas of treatment that may be harmful to them or that we disagree with, it is our job to be patient, listen, respect, and explain and educate.
5. We need to remember that not everyone has savings, a paycheck, a supportive environment, food on the table, transportation. It is easy for us to order, prescribe and tell people to do things without thinking about the things that we take for granted that allow us to have easier lives.  Most of us do not have to choose between our medications and our groceries.

In the era of new technology and new drugs, as long as we perpetuate that we must maintain our humanism and pass it on to the next generation, then the care of our patients can only improve.