The Gold Standard for Humanism in healthcare
Sandra Gold, Ed.D. Co-Founder of the Arnold P. Gold Foundation an organization that strives to keep healthcare human.
Cultural Change Agents in Medicine
The vision for the Arnold P Gold foundation was an evolving one because my husband Arnold Gold, MD was in the fray for having humanistic healthcare because that’s the kind of doctor he was. He found too often that the people around him who he was supposed to be working with and training, were too focused on the great technology and the discoveries in medicine that happened in the 1980s.
He had an overarching goal to foster humanism in medicine, to make it clear how important it was for there to be excellence in the science and use of that wonderful discovery and wonderful new technology. It was so important to the welfare of his patients but also to remember that that’s only half of the skill set needed but the other half had to do with the human condition and the need for connection that people have and I think that that’s all we had. When the board met for the first time, it was clear that this was a bigger project than we had originally thought about and then we realized working out our goals and having a plan that we needed to be cultural change agents. That’s when it crystallized for us that we had a big job in front of us and that there were forces that were going to make for barriers to having humanism in medicine.
Overcoming the Odds in Achieving The Gold Standard
I think that people who have a vision as Arnold did, are passionate and sincere and believe in the argument for the project. Arnold knew that anything less than humanistic care, no matter how skillful, was less than optimal. He fought up the hill and he assigned me the job of getting the money and organizing and administering the foundation and doing the projects he was the spokesperson because it was very clear that he was a well-recognized child neurologist. He had the sixth license in the world.
He came into a new discipline as a fellow and had 88 papers to his credit and wrote most of the textbooks on child neurology at the time, so he was credible. When he spoke about the need for humanism in medicine to philanthropists, they recognized that this was something very important and it was in the plea for it. The willingness to work for it, the willingness to develop projects that would enhance healthcare that they recognize as genuine.
There were detractors, in the academic pile of bricks. Some people said that Arnold is smoking opium if he thinks they could do something about changing medical education or influencing it. But, just recently I had an experience, another one of my daughters who lives here in Boston had emergency surgery this past weekend and she called me up and she said, mom, you won’t believe this story. She told me that the doctors had been wonderful and very patient and spend a lot of time with her explaining options. She told the chief resident who came to discharger what a pleasure it was and how humanistic that she and the surgeon had been and that her parents would have been so happy to see such humanism. The young doctor’s eyes welled up with tears and she looked at my daughter Maggie, and she said, are you the daughter of Dr. Arnold Gold?
And then she said, your parents have changed as she put it, the face of American medical education. And my daughter wanted to report to me that her doctor knew what the movement was all about and represented it so well. And that she called up her surgeon immediately and said, we just operated on Dr. Arnold Gold’s daughter. So I think, that Arnold would be very pleased to have heard that, to have a young chief resident understand and do what was necessary to inform correctly a patient that was going through emergency surgery.
Advice to Healthcare Providers
Humanism in medicine is not far from us, it’s close to us. The connection between people by a health care provider who came into this profession yearning to do good and to help people will find it easy to know what behaviors are good and project humanism, connection, relationship, trust, and what aren’t. I think the key advice I would say is to keep that close to you that it’s doable, it doesn’t take a lot of time because one of the studies that we helped to fund a long, long time ago indicated that when doctors know how to communicate and take some interventions that help you communicate better, that your patients perceive you as spending more time with them.
In a study with people doctors who had communication training and those who had not that this study and it was with the University of Michigan and Columbia, indicated that the patient’s thought that the doctors who had communications training spent more time with them when indeed it was the other way around. So, that’s number one, number two, people will tell you how to practice medicine and to some degree they have controlled when they own your practice or when you’re a nurse on the floor or you’re a young physician and it’s going to be difficult that’s the hard one, in the face of the kinds of a push to see patients quickly – well you’ll know them better than I what barriers are placed between you and your patient. Sometimes the electronic record if it’s not used correctly or is a barrier to your patient, you’ll figure that out yourself if you are a nurse a doctor a social worker, or anyone on the team. You’ll be told and you’ll remember that the doctors who you admire always came into the room and sat down on the same level with their patients and spoke to them.
My husband Arnold used to say if, I heard this just recently after he died by fellows and residents and medical students that he trained. He used to say if you have bad news to give a parent that you’re to sit and you give some news that is not bad and then you give some news that is with problems and heartache and then you give something to do about it. Have a plan, I could give you ten examples that came in letters after he died, about how he did this and they told me that Dr. Gold always told us that when you give bad news to a parent that could be for any family member that you always sit there and answer the questions until you look in the eyes of the parents and you see they have no more questions, then you can leave. You don’t leave before that.
Now in today’s pressure-cooker world of every nine minutes, another patient cannot provide the humanistic connections that are necessary. If the hospitals and the clinics understand that you will get better outcomes if you allow humanism and relationship building you will save money in the end. If you look at the data and you want to have it, we can give it to you. Where you can look it up that eventually will come regression to the mean about how time that you spend will be well spent with your patients that they will adhere to treatment plans better that’s going to save money for a medical care that there will be fewer frivolous lawsuits. I could give you a whole list of good outcomes that will come only if you have humanistic practice.
Key to Humanism in Medicine
Nursing assistants and those that provide real care, hands-on care are the keys to humanism and medicine. Because all the other people are in and out, the doctors, the nurses now they’re doing a lot of administrative stuff. The nursing assistants are the ones that people call for that most often answers the call, just recently one of my three daughters was in the hospital in New Jersey and was in a two-bedded room and the woman in the bed next to us was a person crying for pain all night long.
I watched the nurses and the nurse’s aides as they talked to her, she had dementia as well and so she would be told well I gave you a shout and let’s wait and see and if it doesn’t work in an hour then I’m going to call the doctor. They were patient and kind and even though her daughter who was staying with my daughter and me we’re kept up; I couldn’t stop at the say bravo for these folks who were coming in through the night repeatedly. Sometimes they change off, I think it’s because they had to keep their cool with her and they wanted to be kind. They were trying to help her.
It was a reminder of what the nurses do to battle for humanism in medicine when they’re tired and they’re working through the night, so I always say bravo to the nursing assistants and the nursing aides who are right there for the bedpan. This woman was calling to be moved up in the bed, she must have had hip surgery that I don’t know exactly what happened, but she kept on sliding down she thought, and the nurses would say to her I pulled you up as far as I can. Nothing helped except she was quiet when the nurses were there so that they were giving her what she needed, it was some comfort, some of the other human contact to say to her okay and they did it time and time again.
Medical Ethos & Societal Responsibility
Sometimes people are overwhelmed by the prodigious aspects of the project. We understood something that Eleanor Roosevelt said. She said the only way to begin is to begin. So we didn’t have any big visions about what we wanted to accomplish. We wanted to foster what we knew was good in medicine, what my husband knew was important before the research was able to support the evidence that he had imperatively.
I’d like to say to people who are in the health care professionals keep ethos in your mind, keep always understanding that you have to protect caring for people as the goal. You have to also protect, of course, excellence in the scientific skills needed. No one likes a dumb nice doctor, nurse, or any other healthcare professional. We need to protect and guard what we know is basic to optimal medical care.
I’m hoping that our future leaders, that the people who are involved in Planetree, who are the leaders, they’re parallel in their understanding of the need for patient-centered care and that they will get stronger and we will get stronger and that this will go on and on until we see even more progress.
Preserving Humanism in Medicine
Sometimes I think about where we need to go what we need to do to preserve humanism in medicine and what role the Arnold P foundation can continue to have. We are not there yet. We are far from there. We have people already a predisposition to humanism in medicine who get it and understand it. Then we have what we call the low-hanging fruit who, they get it and they’re on the bandwagon. We have about over 30,000 people in the gold humanism honors society and maybe up to 35,000 now.
So we have a lot of leadership now and we have white coat ceremonies at almost all the medical schools that set expectations for this day one, which was Arnold’s goal. He said, at the end of medical school to get up and say an oath, it’s useless. It’s already four years too late. They’re already the doctors who they’re going to be. It’s very important to get to know the people who are the doubters, the people who have been pushed into positions where their connections to their patients are severed, in a lot of different ways where they’re pressured to do things in a way that they wouldn’t choose to do them. That they would practice medicine differently if they had time. So as Arnold always said in his black bag, he didn’t have a lot of cures, but he had time and he had time to talk to his colleagues, get new ideas, get fresh, to have a lot of time with his residents, and fellows to teach.
Passion for Humanism in Medicine
People ask me why I’m still so passionate about this after 30 years of working on it. I came into this kind of sucked in by my husband who said here’s your job, raise money for this. However, over the years as you get older, you see a lot of people who have serious medical problems in the family, in the neighborhood, in the community. An understanding and reading, the research, and seeing how much pain being sick causes, your life depends on it. I am still passionate about it, I still feel that it’s one of the most important projects that we can have in medicine, to preserve what was good for 2,500 years that a doctor, a nurse, a team health care provider gives that patient care that’s why it was called health care. The human connection and keeping health care human which is our tagline and is high on my list.
Legacy of the Arnold P. Gold Foundation
I think the legacy of the Gold Foundation will be to keep pressuring for, advocating for the human connection in medicine and that our goal of beginning will continue and we’ll a compass more of medicine than we have so far. Although I’m delighted to say that we have made inroads and as you hear other people have said that we have had a huge influence on the face of medical education. It’s only important if that continues, so that’s our goal for the legacy that we’ll have fresh power to clinch the bargain for humanistic here.