Making humanism in medicine more humanistic

Kahlil Gibran writes, “In friendship or in love, the two side by side raise hands together to find what one cannot reach alone.” What types of outcomes can physicians and patients achieve in healing, living, and life when Gibran’s message is incorporated into the physician-patient relationship? Can humanism in medicine become even more humanistic?

“Humanism in medicine” is characterized by the Arnold P. Gold Foundation as respectful and compassionate relationships between physicians, members of a care team, and their patients. This notion emphasizes physician sensitivity and compassion to the values, autonomy, and cultural backgrounds of all patients and families.

Common descriptions of humanism typically include terms such as selflessness, integrity, duty, and respect when describing how physicians should interact. Several studies have reiterated the benefits of humanistic medical care on patient satisfaction, trust in physicians, and improvements in health outcomes. Others have recognized the importance of positive role modeling and participation in intense experiences (i.e., end-of-life care) in helping physicians grow into humanistic healers.

Despite an understanding of these factors and the incorporation of the humanistic curriculum within medical education, humanism in medicine remains a lofty notion for most physicians rather than an achievable solution for burnout and loss of empathy.

Not surprisingly, rising pressures related to academic promotion, administrative burdens, metrics of productivity, reimbursement, and adoption of new technologies remain formidable distractions to sustaining humanism within the daily practice of medicine. Can physicians do better?

In my review, I find that one major component is unfairly, but understandably, de-emphasized within patient-centric notions of “humanism in medicine.” This major element is the physician. Why should this role (“the helper”) take on such importance in the noble profession of delivering care to those in need (“the helped”)? In a patient- or customer-focused era, could this selfishly misdirect goals of care?

To avoid downfalls, the consideration of the physician, by the physician, cannot be egocentric or attended to in isolation.

Instead, I would argue for a more balanced approach to the whole (physician-patient) relationship. In a marriage of partners, for example, each individual provides the best support for the other only if they concurrently address their own needs. Similarly, the physician cannot ignore self-care in their pursuit of excellent patient care. This revision in attitude has the potential to improve patient-centered outcomes more effectively than a martyred approach that is singularly focused on the patient.

Both parties are offered potential for enhanced security, fulfillment, and health from the relationship. From this, both find themselves in better positions to offer and receive gestures of help in a manner that is less threatening. Ironically, within this synergistic model, the distinction between “the helper” and “the helped” becomes blurry, and perhaps insignificant.

Some may argue that the physician-patient relationship is not an appropriate setting for the physician to be “helped.” This conclusion ignores the realities of any relationship. It fails to acknowledge and legitimize physicians as humans — individuals who both help and receive help through connection. It additionally dismisses the therapeutic effect patients have on physicians and burnout syndrome — which has only recently been identified as a legitimate medical diagnosis by the World Health Organization’s Revision of International Classification of Diseases (ICD-11).

Studies that have explored factors necessary to sustain humanism frequently elaborate on physicians establishing habits of self-care. These include making time for self-reflection, work-life balance, mindfulness, spiritual practice, connecting with patients, and pursuing meaningful moments within one’s profession.

Impressively, educational programs for physicians that incorporate mindfulness, self-awareness, and stress reduction have not only resulted in improvements in physician burnout, mood disturbance, and empathy but have also demonstrated decreases in medication errors and malpractice claims.

Reductions in physician burnout additionally have a positive impact on patient adherence to medical therapy and patient satisfaction with medical care. These findings reinforce the conclusion that the pursuits of physician self-care and patient-care do not need to compete at the expense of the other. Physicians and patients can, in fact, thrive in symbiosis.

Emphasizing physician self-care within one’s understanding of this sacred (physician-patient) relationship may not be just what the doctor needed, but also improve patient-centered outcomes based on “what the doctor ordered.” Though simple in concept, we require a societal change of epidemic proportions to integrate these ideas into practice truly.

In the modern era where physician care has finally found advocacy, we must expand traditional notions of “humanism in medicine” to emphasize the intimate connection between physician health and patient wellness. This may improve the assimilation of this noble concept, enhance care to all (regardless of role), and preserve the occasionally forgotten humanity for the patient … and the physician.

Ajay Khilanani is a pediatric critical care physician.

Image credit: Shutterstock.com 

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