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Daniel M. Lichtstein, M.D., MACP Professor of Medicine Regional Dean for Medical Education University of Miami Miller School of Medicine
Daniel M. Lichtstein, M.D., MACP
Professor of Medicine
Regional Dean for Medical Education
University of Miami Miller School of Medicine
Objectives 1. To better understand the role of humanism
in medicine
2. To understand the role and importance of civility in medicine and in our personal lives
3. To use anecdotes to illustrate examples of humanism and civility
In accordance with the guidelines of the Florida Medical Association/Accreditation Council for Continuing Medical Education, Dr. Lichtstein
has indicated that he has no conflict of interest to disclose that will affect his ability to present
an unbiased presentation.
The planning committee for this activity has also indicated that they have no conflict of interest to disclose which influenced their ability to plan an
unbiased presentation.
“Filling buckets”
“Each of us identified the core mission of medicine, making a meaningful difference in someone else’s life-healing if possible, alleviating suffering and fear if not, or simply caring-as the ingredient that filled our buckets.”
Matthew Press, M.D., Timothy Judson MPH, and Allan Detsky, M.D., PhD
JAMA, May 14, 2014
Timothy Judson: M-3 student
Dr. Press: Junior Faculty
Dr. Detsky: Senior Faculty
“The Language of Experience”
“Experience teaches us to recognize what really matters to people, to sift through the routine and the remarkable, to separate the trivial from the true essence of a patient’s needs. To recognize that to serve our patients we must adapt to them, to learn to see things through their eyes, to work on their terms. Medical school teaches us to speak the universal language of medicine, but our patients teach us to understand it.”
Jesse Raiten, MD A Piece of My Mind
JAMA, September 10, 2014
What is humanism?
What is humanism in medicine?
Humanism in Medicine
From the Arnold P. Gold Foundation (2013) “Humanism in medicine describes relationships between
physicians and their patients that are respectful and compassionate. It is reflected in attitudes and behaviors that are sensitive to the values, autonomy, cultural and ethnic backgrounds of others.”
“A humanistic doctor demonstrates the following attributes” (I.E., C.A.R.E.S.)
Integrity Excellence Compassion Altruism Respect Empathy Service
Bernard Lown, M.D. Renowned Cardiologist and Nobel Peace Prize
Winner
The Lost Art of Healing Bernard Lown, M.D.
Anatole Broyard, essayist, wrote this to his doctor shortly before his death from prostate cancer:
“I wouldn’t demand a lot of my doctor’s time. I just wish he would brood on my situation for perhaps five minutes, that he would give me his whole mind just once, be bonded with me for a brief space, survey my soul as well as my flesh to get at my illness, for each man is ill in his own way…Just as he orders blood tests and bone scans of my body, I’d like my doctor to scan me, to grope for my spirit as well as my prostate. Without some such recognition, I am nothing but my illness.”
Fernando González 20th century Colombian philosopher
Oblivion A Memoir
Héctor Abad
González’s description of the ideal doctor:
“The professor of medicine must be out on the road, observing, handling, seeing, listening, touching, struggling to heal, with a string of apprentices… Yes, young doctors: it is not about being kind and sending out large bills and selling vitamin pills…it is about sending you out to heal, to invent, and in a word, to serve.”
The Best Possible Day NY Times 10/5/2014
“People want to share memories, pass on wisdoms and keepsakes, connect with loved ones, and to make some last contributions to the world. These moments are among life’s most important, for both the dying and those left behind.”
From “Being Mortal: Medicine and What Matters in the End”
Atul Gawande, M.D.
More from “Being Mortal” Atul Gawande, M.D.
Referring to Gerasim, Ivan Ilyich’s servant in Tolstoy’s “The Death of Ivan Ilyich, 1886”, as Ivan was fading: “This simple but profound service-to grasp a fading man’s need for everyday comforts, for companionship, for help achieving his modest aims…” Gawande: “As people become aware of the finitude of their life, they do not ask for much…they ask only to be permitted to keep shaping the story of their life in the world-to make choices and sustain connections to others according to their own priorities.”
“Time Will Tell”
“Instead of hoping to indefinitely stave off death, we can hope for the most meaningful and peaceful end of life.”
Bryan Sisk, MD
A Piece of My Mind
JAMA, March 17, 2015
A close colleague’s definition of humanism
“…to forge a bond with our patients and their families that makes them feel respected and very active partners in the doctor-patient relationship. Competence, compassion and empathy are also givens if one is truly practicing the art of medicine. Integrity, altruism and a true sense of service are also characteristics that anyone in the healing arts should have in abundance.”
James M. Cooper, M.D.,FACP
“Vocabulary of Caring”
Beneficence: Latin for “active kindness”
Empathy: “in feeling”
Sympathy: “like feeling”
Compassion: “to suffer with”
Penelope S. Fisher, M.S., R.N. Clinical Instructor, Department of Otolaryngology
UMMSM, Sylvester CCC
2014 recipient of the first “Penelope S. Fisher Award for Outstanding Humanism in Clinical Care and Clinical Education”
In 2006, she started a primary nursing program that paired nurses and physicians with patients so that patients would see and interact with the same nurse at every visit.
More about Penelope Fisher…
A patient’s wife wrote to thank her for her patience and kindness after contacting her about her husband’s sarcoma:
“I just want to thank you for generously giving me your time and even pulling your car over so we could
talk.”
She keeps a drawer of notes from patients and family members and says “…after all the things we endure with our patients, some tell you how you helped them and that is quite possibly the greatest moment of all.”
More…
She goes on to say:
“In our daily world we may only get one minute to make the difference in an interaction, transaction or
intervention that changes an outcome. All of our outcomes must be founded in the value of human beings, individually, collectively and generally. For it is then we
have truly practiced in the meaning of the art and science of caring.”
Paul Farmer, M.D., PhD Professor of Medical Anthropology, Harvard Medical School
Founding Director, Partners in Health
Medical Director of a hospital in rural Haiti, the Clinique Bon Sauveur
He advocates for equitable health care for the most vulnerable and most needy
“Anyone who wishes to be considered humane has ample cause to consider what it means to be sick and poor in the era of globalization and scientific advancement.”
Sir William Osler Turn of the century educator
Osler’s motto, according to one of his medical students
“Do the kind thing and do it first.”
Osler’s letter to the parents of a young man who died of smallpox
An act of compassion (humanism)
A young man he had just met
Smallpox was diagnosed; disease progressed rapidly, and the patient expired
Osler wrote a detailed and factual letter to the young man’s parents describing exactly what had occurred, and that their son received excellent care
Explained that as he was dying, the man talked about his mother and died peacefully
30 yrs later, the man’s sister expressed gratitude on behalf of her mother for the letter he had sent
Humanism does not always have to directly involve patients
Osler kept pre-stamped postcards handy at all times
Would drop a quick note of congratulations or best wishes to a colleague or student
Sometimes, he would just write: “I am thinking of you.”
William Wordsworth 18th-19th century English poet
“The best portion of a good man’s life is his little, nameless, unremembered acts of kindness and of love.”
John Gregory, M.D. Mid-18th century Scottish physician
One of the first physicians to have a major influence on American bioethics.
Taught that the practice of medicine required sympathy.
“Tenderness, gentleness, flexibility…”
Of the physician’s character, “The chief quality is humanity…”
Anecdotes from colleagues
The mother of one of my colleagues is a pediatric intensivist: a decision to disconnect a baby from a ventilator
A colleague who stood by a patient with alcoholism for years to help him maintain sobriety and reconnect with his family
In a letter to the physician, the patient said, “With your help and encouragement I have become a better father, friend and person than I ever dreamt of becoming.”
Personal anecdotes
An elderly woman with unexplained pre-renal azotemia
An elderly woman discharged to home after a nursing home stay for a hip fracture
Home visits at the end of life
“Choosing Civility” The Twenty-Five Rules of
Considerate Conduct P.M. Forni
Co-founder of the Johns Hopkins Civility Project
Henry James Anglo-American writer, 19th century
“Three things in human life are important: the first is to be kind. The second is to be kind. And the third is to be kind.”
From a medical school applicant’s personal statement
A physician the applicant had spent time with shadowing said,
“If you learn nothing else from me, learn to always treat your patients with kindness.
Every man is someone’s son. Every woman is someone’s daughter.”
From a physician reflecting on the care her mother received in the hospital
“…being on the other side made something painfully clear. I realized that the face-to-face contact, the words, the silence, the facial expression, the touch-all that make up the human interaction of the physician-cannot take place behind the scenes. …the palpably human presence of the physician is critical to addressing the patient’s (and family’s) vulnerability during any state of illness.”
“The Other Side” Ann Intern Med
September 16, 2014
What is civility? A few examples from “Choosing Civility”
Respect for others
Care
Consideration
Courtesy
Politeness
Kindness
Fairness
Self-control
Justice
Selflessness
Etiquette
Community service
Honesty
Morality
Moderation
Listening
Compassion
Lending a hand
“What is civility?”…
Dr. Forni concludes:
“civility is complex”
“civility is good”
“whatever civility might be, it has to do with courtesy, politeness, and good manners”
“civility belongs in the realm of ethics”
You know it when you see it!
Anecdote
What should you do when you are planning to retire or leave your practice?
What is your responsibility?
Is that enough?
Practicing civility
Patients:
Wish to say goodbye
Express their thanks
Ask for guidance about their care
Have one last “check-up” with you
Physicians:
Say “thank you for entrusting your care to me”
What to do “if you need me”
Express confidence in your “replacement”
Thank you!
If anyone has any comment or anecdote to share…
