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Practicing Humanistic Medicine
By Paul. B. Rothman, M.D.
One of our School of Medicine’s founding fathers, William Osler, was an advocate of patient-centered care before the term even existed in the late 19th century. He once said: “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients doesn’t go to sea at all.” He also said: “Listen to your patient. He is telling you the diagnosis.”
Today, one of our institutional priorities is to be the national leader in the provision and teaching of patient- and family-centered care. And many of us in the profession are wrestling with how to balance cutting-edge medicine and life-saving technologies with the need for a human touch and listening to what a patient wants and values.
On one hand, the central precept of the profession is compassion. Many of us get into the field to help our fellow humans and relieve suffering. On the other hand, there have always been powerful factors working against humanism in the practice of medicine, including:
- The need to study and master vast quantities of highly technical information
- Time constraints
- The need to handle large volumes of patients
- The distancing effect of increasingly sophisticated technologies
- More bureaucracy and documentation
- Burnout or disillusionment
The good news is medical training has been trending in a more humanistic direction over the past decade in our attempts to produce a more compassionate workforce. Changes in medical schools’ selection criteria produces more caring physicians. For example, at Johns Hopkins, we don’t just look at MCAT scores, but also at the candidate’s interests and activities, where they’ve volunteered, and what their recommenders say about their character in their letters of support.
There have also been positive changes to both the medical school curriculum and the residency model. Under our revamped Genes to Society curriculum, students begin speaking with patients in the clinic in the first week of medical school and focus on the impact that social, community and environmental issues have on the health of individuals. We’ve also made great strides in our residency training. Work hours have been reined in for interns and residents, we incentivize the mentorship of our trainees, and we require them to participate in service projects to help them develop empathy and the ability to relate to people of different backgrounds.
Healthcare providers have also adopted policies to preserve the intimacy of the physician/patient relationship, including setting up exam rooms to keep the laptop for taking notes out of the way, so the doctor can still face and make eye contact with the patient. We are also moving toward exclusively single-patient rooms in all of our hospitals, in part so that patients’ conversations with their doctors are more private.
Patients are people with feelings, opinions and goals. As physicians, it behooves us to get the patient involved in the healing process – to try to understand their goals and find the path that best meets their needs. Caring doctors are better doctors. They practice safer medicine, earn more trust from patients and get them more engaged in their healthcare, leading to better outcomes. To lead this change, we must find the proper balance between the time-intensive demands of a patient-centric approach to care with the need to handle a growing volume of patients.
- “Letting Go,” The New Yorker, August 2010 – Atul Gawande’s piece on end-of-life care won a National Magazine Award and addressed the question of whether we’ve stripped dying patients of their humanity.