Grant promotes empathy by example

No one would deny the value of the biotechnological revolution for medical care, but as medicine became more of a science, many doctors and patients voiced the concern that the personal aspect of care—medical humanism—was losing ground. The School of Medicine has long tried to buck that trend, and thanks to a two-year, $2,000 pilot grant received last fall, the school and the Yale New Haven Health System (YNHHS) have established a program to encourage and honor residents who demonstrate a capacity for humanism and patient-centered care.

Funded by the Gold Foundation, a New York-based non-profit whose goal is to “nurture and preserve the tradition of the caring physician,” Yale’s Resident Chapter of the Gold Humanism Honor Society (GHHS) inducted its first honorees on May 16. This group of 56 residents was chosen from among the system’s 1,100 residents and fellows through peer nomination and review by members of the chapter’s organizing committee. Each potential inductee had to write a short statement that explained how humanism was playing out in their lives as doctors.

A precise definition of humanistic care is not easy to come by, admits the chapter’s faculty advisor, Auguste H. Fortin VI, M.D., M.P.H., associate professor of medicine. But, echoing Supreme Court justice Potter Stewart on another slippery concept, even if he can’t describe it, Fortin knows humanism when he sees it—and experiences it. “It’s the kind of care that I’d like my mother to receive,” he said. “It’s more than just technically and scientifically correct medicine. It’s care that pays attention to the entire personhood of the patient.”

Leo Moore, M.D., a second-year resident in primary care internal medicine who was instrumental in organizing the chapter, explained that it was too early to know precisely how current members will accomplish their lofty goals. “We’re hoping to spread the gospel, and we came up with multiple ways we might start to do this,” said Moore.

One popular idea that emerged during early discussions was a silent auction to raise funds for health care for the underserved. Another was a lecture series that would offer a Yale perspective on humanism-in-medicine talks sponsored by the Gold Foundation. “At a lecture on, say, poetic expression in medicine,” said Moore, “we’d give everyone time to jot down and share their thoughts and their patient experiences.”

As an example of humanism in action, Moore told the story of a patient, a woman with end-stage renal disease who had developed calciphylaxis, a potentially fatal condition in which calcium accumulates in the blood vessels in the skin and causes ulcers. “She was a full-code, and she’d been pushing and pushing to live, but we’d come to a fork in the road,” said Moore. “She was in an immense amount of pain, and we could have simply continued treating her by scraping the lesions—or we could have provided only comfort measures, which would have eased her into the transition of death.”

The woman’s care team—a chaplain, the patient, and her family, along with the medical staff—worked together to come up with a humanistic approach. “The chaplain told her that God didn’t want her to suffer, and after she heard that, she was able to let go,” said Moore. “If we weren’t taking the humanistic approach we would have just looked at the woman’s code status and started an aggressive treatment like debridement, which would have been even more painful and, perhaps, futile.”

Moore and third-year primary care resident Jing Luo, M.D., and Rajitha Devadoss, M.D., a third-year pediatrics resident, were part of a group of approximately 30 physicians who had been identified as Gold Foundation “alums” by Rosemarie L. Fisher, M.D., associate dean of graduate medical education. Some had been inducted into the GHHS in medical school; others had received the Foundation’s Leonard Tow Humanism in Medicine Award. All had demonstrated a commitment to patient-centered medical care.

About two years ago, Fisher was on a Gold Foundation committee that was discussing ways to bring residents into the fold and came up with the idea of creating resident chapters. “I knew we had to get involved,” she said. Fisher, Fortin, Moore, Luo, and Devadoss wrote a grant proposal, and last fall, the medical school and YNHHS became one of 10 organizations nationwide awarded a pilot grant.

“There’s an unfilled need to recognize people for their humanism,” said Fisher, noting that her office has already decided to provide chapter funding beyond the initial grant period. “Everyone needs a little pat on the back sometimes.”

All of the Gold alums were asked to become part of an informal group that would determine the scope and direction of the GHHS Resident Chapter. But they weren’t given mandates from the Foundation, explained Devadoss, who, as a member of the Foundation’s national advisory council, was also instrumental in voicing the need for the resident chapters.

“There’s no precedent, so each institution was allowed to develop its own take on how to do this,” said Devadoss. In discussing her hopes for the chapter, she voiced a common thread. “Residency can be a difficult time, with long hours and constant pressure to see as many patients as possible, and it’s easy to forget the core values of patient-centered care you learned in medical school—and that made many of us want to become doctors in the first place,” she explained. “We envisioned the chapter as a way to bring residents together to support, inspire, and nurture humanism in medicine.”

At Yale, the inductees are part of a tradition at the School of Medicine, which has long embraced the humanistic ideal. “By honoring, early in their careers, what these young physicians are doing,” said Fortin, “we’re reinforcing humanistic behavior and increasing their visibility as role models for their colleagues and our medical students.”