Treating the Patient, Not the Disease: Fred Schiffman on Humanism in Medicine

In this interview we discuss humanistic medicine and some of the skills that physicians need in order to have open communication with their cancer patients, which can improve the quality of cancer care.

1. What do you believe is currently missing in many of the interactions between physicians and patients?

DR. SCHIFFMAN: As we try to deliver humanistic care to our patients, there have always been issues and obstacles, but humanistic care is now under new assault for a whole variety of reasons-part of it has to do with technology, and part of it has to do with time and availability of physicians to see patients among their other tasks. We are all being assailed by busywork and insurance requirements for patients. Our patients are often desperately ill, and we are required to certify needs for getting tests that we, as physicians, think are important. When the use of electronic medical records is added to our task list, it’s a time sink. It takes a lot longer than any of us would wish, and we really would rather focus on our patients.

There are some advantages of electronic medical records-legibility, complete records for all care, remote accessibility, and the fact that all caregivers can participate in the same record. It’s also organized, you can e-prescribe easily, and you can monitor chronic disease and do population health studies. However, the use of electronic medical records has nothing to do with interactions with patients; patients don’t speak “template.” The complete electronic record requires attention, and there are a whole series of new mistakes we can make, with legal implications, which can make our day longer. Charting, according to good evidence, takes 25% to 30% longer, which means our very important time at home with our families and children is taken up by attention to this medical record. It should be noted that these records have never been shown, in any study that I know about, to unequivocally improve quality and safety, but have been shown to add to physicians’ burnout and degradation in work-life balance and resiliency.

2. During your presentation at the American Society of Hematology (ASH) Annual Meeting in December, you said that both humanism and professionalism are necessary to provide the best possible care for cancer patients. Could you define what you mean by these two terms in this specific context?

DR. SCHIFFMAN: The fact that we have to add the word “humanism” to medicine is, I think, a very sad indicator that medicine is often now bereft of humanistic concerns and ideals. Humanistic medical care comprises integrity, excellence, compassion, altruism, respect, service, and empathy. Humanism fosters compassionate and empathic relationships with patients and colleagues. It demonstrates attitudes and behaviors that are sensitive to the values, autonomy, and cultural and ethnic backgrounds of patients. Professionalism includes subordinating our own interests to the interests of those we serve, and just like with humanism, we must adhere to high standards and respond to societal needs. We advance core humanistic values if we are professional and we exercise accountability, demonstrate commitment to excellence and scholarship, and deal with complexity and uncertainty.

As professionals, we should be reflecting upon our actions and our decisions. Art and science are needed and you can’t really practice medicine without being excellent. You can’t be a good caregiver. I also try to make the distinction between curing and healing. With curing, the provider directs efforts towards the physical manifestation of the illness; the focus is on the elimination of symptoms and signs of disease. In order to heal, we must direct our efforts towards the effects of the illness on the patient beyond physical manifestations, including social, psychological, and spiritual effects. The medical record and robots that we use, as well as other technical additions to our armamentarium, often have the unexpected-and frankly unwanted -effects of interfering with our own resilience and our own ability to care for patients.

3. What are the important skills that physicians need to develop and hone to better focus on patients’ needs, as well as those of their family and caregivers?

DR. SCHIFFMAN: I have colleagues at the University of Chicago, especially Wei Wei Lee, MD, who have really perfected the art and skill of using electronic medical records. Positioning of the computer in the room is key to creating this triangle of trust, making certain that we teach patients using our computers, that we integrate this into clinical care, that we explain what we are doing, and that we turn off the computer during sensitive periods. Also, you should respect the “golden minute”-that when you walk into the room, you don’t even acknowledge that the computer is there and you just talk to the patient, hold his hand if necessary, look into his eyes, and find out what he is feeling. Another thing to remember is that the patient should be more than the sum of what is appearing on the computer screen. We must honor narrative medicine and patients’ stories, and acknowledge that science is the mind of medicine but humanities are the heart of medicine.

Roy Ziegelstein, MD, at Johns Hopkins, calls getting to know patients as people “personomics”-understanding their concerns, their personal relationships, their hobbies, their work, and what you can add to their care, to almost counterbalance the technical aspects of the patient-physician interaction.

4. Lastly, what advice do you have for physicians to help them improve their own quality of life?

DR. SCHIFFMAN: I think that wellness, work-life balance, and avoidance of burnout are absolutely critical. I think being mindful, knowing your professional identity, what you need to recharge your batteries, and what you need to make yourself happy are very important-whether it is yoga, meditation, the gym, or eating well. Sharing some of these information bits with your own patients helps you as a caregiver, and it helps your patients understand who you are and what your relationship can be to them. There are plenty of things you can do to restore and maintain your own health as a caregiver so that you can be strong and resilient for your patients.

Financial Disclosure:The author has no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article.

Interview conducted by Anna Azvolinsky. A slightly different version of this interview was published online in December 2016.