Nearly 20 years ago, Arnold P. Gold, MD, a pediatric neurologist, and his wife, Sandra O. Gold, EdD, a psychologist, created the Arnold P. Gold Foundation to foster the humanistic side of medical education. The Foundation has encouraged schools to establish a ceremony in which new medical students are given a white coat and encouraged to become caring physicians from their first days of medical school. Almost all U.S. medical schools participate in the ceremony.
Last year, Jordan J. Cohen, MACP, became chairman of the Gold Foundation. Despite the current climate that tends to impede a close doctor-patient relationship, Dr. Cohen believes that the Arnold P. Gold Foundation can help nurture humanism in medical students and newly minted doctors. He talked to ACP Hospitalist about why some physicians have lost their personal connection with patients, and why he believes that creating humanistic physicians is so important.
Q: What are some of the barriers that could impede medical students and residents from becoming caring doctors?
A: There are many barriers. First of all, the seduction of new technology is so captivating, so appealing, that there is a perception that that's what medicine is: just a matter of getting the right answer and doing the right thing. That is a superficial view of what the fundamental values of medicine are all about. We have become so enamored of the technology that we tend to forget the basic commitment the physicians must have to the patient-doctor relationship.
The commercialism that's so common in medicine now also is a barrier to these core values. Medicine is viewed by many outside the profession and, unfortunately, by many inside the profession as just another business. There is a tendency to view interactions between doctor and patient [as] analogous to a vendor and a customer, rather than a doctor and a patient receiving compassionate care. Commercialism is an ethic that is fundamentally at odds with the profession.
Q: Do you feel like this shortcoming is changing with the work that the Foundation is doing?
A: The Foundation has been remarkably successful in a fairly short period of time with very limited resources. It's my impression that the tide is shifting, and there is much more awareness and attention being paid to the caring aspects of our profession as well as to the obvious importance of technical and skill-based issues. We are making progress, and I am very proud of what the Foundation has been able to contribute to that change.
Q: What do you think are the most significant ways that the Foundation has contributed?
A: The vast majority of medical schools now have some form of the white-coat ceremony, which is the signature program of the Foundation and the first thing that [it] promoted. A relatively new and potentially the most durable of our programs is the Gold Humanism Honor Society. About 70 medical schools in the country have an honor society. It is our hope and expectation that each one will become a local change agent for their institution by exemplifying the importance of humanism in medicine.
Not only do the honor societies recognize and provide appropriate visibility to those students selected by their peers for their especially noteworthy qualities of professionalism and humanism, but the expectation is that these individuals, plus selected residents and faculty, will create programs that are specific to their institutions. Be they community action programs, ethics lectures or other kinds of activities, these programs can enliven the commitment to humanism and professionalism in their respective schools. Over the long run, this may well become the most important initiative that the Foundation supports.
Q: How does your previous role as president of the Association of American Medical Colleges influence the current work you are doing for the Gold Foundation?
A: Well, as president of the AAMC, I had the privilege of seeing the Association take strong positions in support of professionalism and humanism in medical education. I tried to do a number of things to underscore these values, and so it was a natural transition from those experiences to trying to do something about the issues that the Gold Foundation is pursuing.
Q: Do you think that the lack of humanism is generational? In other words, as Generation X doctors replace baby boomers, could the pendulum swing back the other way?
A: Students who are attracted to medicine today are among the most idealistic I've ever seen. So, I am very hopeful about that generational change. The worry is that their acculturation to medicine often sends a different signal. The idealism that many bring to medical school, rather than being reinforced, tends to wither. The goal of the Gold Foundation is to underscore the importance of developing a professional view, and recognizing the innate capacity and inclination of students to be humanistic professionally ... to reinforce that, develop it, honor it. [The goal is] to strengthen students' willingness and ability to maintain those attitudes throughout their careers.
Q: Can you point to some medical reasons why having a humanistic doctor is important?
A: When patients and [the] public in general are polled about what they want in their physicians, they articulate issues such as communication, spending time with them and trying to understand them as human beings. It has also been well established that patients who have a good relationship with their physicians are more compliant with medical advice and do better as a result. There is a connection between physicians who are committed to this kind of approach to the doctor-patient relationship and how their patients experience interactions with health care providers.
Q: Despite the pressure on office-based physicians to see many patients, is it still possible for them to reach out in a human, emotional way?
A: There's no question that physicians in practice today have many demands on their time. They are obliged to see more patients and to shorten the time that they have with each, but I don't think that's a justification for abandoning our core principles. As Francis Weld Peabody famously said a century ago, the key to the care of patients is caring for the patient.