Doc Newsletter Fall 2012

Passing the Torchin the Century of BiologyThe Gold Foundation names Dr Richard I Levinas new President and CEOA Message from SandraLike William James I deeply believe that ldquothe use of life is to spend it on something that will outlast itrdquo Thatrsquos why I am so delighted to announce that Richard I Levin MDan internationally recognized medical scholar and most recently Dean at McGill MedicalSchool in Montreal has joined the leadership of The Gold Foundation as President andCEO I feel assured that the humanistic mission of the Foundation will significantly advance under his wise direction and its future is now secure ndash Sandra O Gold EdD Senior Counselor to the President

A Message from RichI am delighted to join in the incredibly important work of inventing the future of the foundation Standing on the shoulders of founders Sandra and Arnold Gold I am deeplyhonored and excited about my new position and feel certain that my passion for the mission -critical to the citizens of our nation if not the world ndash will move us rapidly forward to writethe next chapter

Medicine in America is at a tipping point and has begun a revitalization that will transformhealthcare and make the patient-doctor relationship even more important than it has beenJust as the Renaissance allowed the establishment of humanism as a philosophy thisrenaissance in medicine in the Century of Biology will require an even greater focus on hu-manistic aspects of care The Gold Foundation is perfectly positioned to lead this revival

Interdisciplinary science and the transferring of the ldquosecretrdquo knowledge of scientists to thepublic will be key Equally key is what the Foundation has begun and succeeded at so well ndashdeveloping rituals and opportunities to push the pendulum back toward a balance betweentechnologist and healer Many physicians will need to become capable of explaining withcompassion and wisdom what the secrets of their patientsrsquo genetic heritage imply TheFoundation can be the nexus for such change

Long before joining the Foundation I have had a personal history with it As a student prac-titioner and Dean APGFrsquos mission was my personal ethos It began philosophically with mytraining at Bellevue in the 70rsquos in the pre-technological age where I learned the importanceof the physician as trustee for each patient Holding the patientrsquos hand was often the onlytherapeutically useful tool we had Then as teacher and mentor of generations of students ahighpoint of the academic year was delivering a keynote address at the White Coat Cere-mony And in a moment of pride and celebration beyond the sublime in 2008 I stood asMentor when my daughter Jennifer was elected to the GHHS at Dartmouth

Throughout my life I have been dedicated to and passionate about excellence We are in a period of great reformation and potential and while our models and resources are undertremendous pressure this is an extraordinary era in which striving for excellence is the keyThe opportunities are exceptional but are well within our reach if we act collaboratively creatively and efficiently to invent the future and ldquokeep the care in healthcarerdquo

ndash Richard I Levin MD President and CEO

wwwhumanism-in-medicineorg

Working to keep the care in healthcare

Fall 2012

L to R Dr Sandra Gold amp Dr Arnold P GoldDr Richard Levin amp Jane Levin Esq

Dr Richard I LevinA Short Biographical TimelineThis biography represents an attenuated version of Dr Levinrsquos accomplishments1970BS in Biology Honores in Biologia Yale University 1973MD New York University School of Medicine1974Elected to Alpha Omega Alpha1979-1983Postdoctoral Fellowship Vascular BiologyCornell University Medical College1983Fellow American College of CardiologyFellow American College of Physicians

1986-1989Councilor Eastern Section American Federationfor Medical Research1995-1996President American Heart Association NYC Affiliate1996-2006Attending in Medicine Tisch Hospital NYU Medical Center1998-2000Board of Directors American Heart Association Na-tional Organization2000-2006Vice Dean for Education Faculty and Academic Af-fairs NYU School of Medicine2001-2004President American Heart AssociationHeritage Affiliate2006-2011Dean Faculty of Medicine amp Vice Principal for HealthAffairs McGill University 2006Attending Emeritus in Medicine Bellevue Hospital Center2011-2012Senior Scholar in Residence Association of Aca-demic Health Centers2012President amp CEO of The Arnold P Gold Foundation

Humanismrsquos Future in HealthcareldquoWhat concerns you most about the direction you see American healthcare takingin relation to assuring the caring relationship between patient and doctorrdquo is thequestion we asked guests to discuss at this yearrsquos White Coat Ceremony DinnerHere are some of the most common concerns identified with responses provided byour new President and CEO Dr Richard Levin and the Chair of APGFrsquos Board ofTrustees Dr Jordan Cohen

QUESTION Do todayrsquos physicians have a communications problem

Rich Yes on several levels Most physicians are now salaried employees and efficiency is demanded by the system in which they practice Time is limited andrecord keeping is becoming electronic which does take time away from interactingwith patients On another level there is perception that the narrative caring interviewis not of value The Foundationrsquos focus is to change that perception Jordan do youagree

Jordan I do agree And thatrsquos why Irsquom pleased to see medical schools paying a lotmore attention to nurturing studentsrsquo communication skills New techniques such asthe use of standardized patient simulation which involves the use of individualstrained to portray the roles of patients family members or others are being used toteach and to evaluate the ability of future doctors to talk and listen to patients

QUESTION How much pressure do doctors feel to see more and more patientsCanrsquot technology help with this

Rich As payors have reduced payments for standard ldquocognitiverdquo care in favor of procedural care doctors have been forced to squeeze in more visits to try tomaintain income Also there is a physician shortage which doesnrsquot helpUnfortunately technology and the new media are only just developing in this arenaThey are ldquohalf-way technologiesrdquo as Lewis Thomas called them and canrsquot yet savetime for most physicians

Jordan Most doctors are still subject to financial incentives to see as many patientsas they can because most insurance companies still use the fee-for-service methodto pay doctors for what they do Happily we are seeing a shift toward differentfinancing methods that value the quality rather than the quantity of patient care Weare also depending more and more on new technologies to provide good measuresof quality care

QUESTION Will the shortage of physicians lead to a crisis of access Is it true that more doctors are retiring now

Rich Recent surveys suggest that doctors will retire at an earlier age partiallybecause of the large number of doctors who are part of the baby boom generationSurveys indicate that many doctors have become dissatisfied with practicing medicineand desire to retire early The Gold Foundation will begin programs to help improvepractice conditions to fight this trend

Jordan Whether or not doctors choose to retire earlier we are likely to face a shortage of doctors as our population ages and as demand for healthcare servicesincreases In order to avoid a ldquocrisis of accessrdquo we need to enlist the help of otherhealthcare professionals ndash nurses physician assistants pharmacists and others

QUESTION Has ldquocorporatizationrdquo of care depersonalized medical practice

Rich These issues are not necessarily automatically linked Some large practiceshave made patient centrality and humanistic care part of the plan

Jordan Rich is right creating integrated healthcare systems ie corporatizing careneed not depersonalize medical practice But such organizations must recognize andreward humanistic physicians if we are going to retain the focus on patients andkeep the care in healthcare

Physicians Experiencing Burnout atHigher Levels Than General Population

of physicians said they experienced burnout symptoms

of those in the general US workforce said they did

of physicians said they were dissatis-fied with their work-life balance

of those in the general US workforce said they were

of physicians reported working 60hours weekly or more

of those in the general US workforce did

of physicians reported highdepersonalization

of those in the general US workforce did

Nearly half of the physician respondents reported at least oneburnout symptom

Shanafelt TD et al Burnout and satisfaction withwork-life balance among US physicians relative tothe general US population Arch Intern Med 2012101001archinternmed20123199The study evaluated rates of burnout and job satis-faction among 7288 US physicians and comparedscores between specialties and with a sample of theUS general work force Respondents tended to beolder and graduated from medical school longer agothan the total physician population

APGF Initiates New Research Institutefor Humanism in MedicineMany people believe that while empathy and compassion are admirable traits in adoctor strictly speaking they are a nicety However science is now beginning todemonstrate that being a humanistic doctor has a direct and positive impact onpatientsrsquo healthcare outcomes With the increasing number of individuals entering the already strained healthcare system as a result of the Affordable Care Act thepractice of humanistic medicine could become a casualty

To ensure that the importance of key elements in the doctor-patient relationship is not diverted in the implementation of the ACA The Gold Foundation is developing an institute for research on humanism in medicine The institute will facilitate and disseminate research to better define the role of compassion and respect in the delivery of high quality health care

ldquoSubstantiating the impact of compassion empathy good communication and cultural awareness on the outcomes of care is critically important as we embark onfundamental reforms of our healthcare system We must not lose sight of these invaluable aspects of high quality care as we explore more efficient and less costlymodels of healthcare deliveryrdquo said Gold Foundation Board Chair Jordan J Cohen MDimmediate past President of the Association of American Medical Colleges

The institute will provide a source of funding and technical assistance for investigatorsinterested in understanding how humanistic care contributes to patient outcomesSpecial emphasis will be placed on identifying or creating valid and reliable tools forevaluating patient care provided by individuals and teams of healthcare professionalsThe institute will also assemble relevant research results from other sources and willserve as a central resource for updated information about humanism in medicine

ldquoNow more than ever evidence of the impact of humanistic relationship-centeredmethods and models of healthcare must inform how we practice and educate thenext generation of health professionalsrdquo said Elizabeth Gaufberg MD MPH GoldFoundation Professor and an Associate Professor of Medicine and Psychiatry atHarvard Medical SchoolCambridge Health Alliance Dr Gaufberg will serve as theinstitutersquos founding director

In addition to Dr Gaufberg current staffing plans include a health sciences researchlibrarian The research housed on the institutersquos website will be available to policymakers healthcare professionals journalists and the public

Currently in development the institute is seeking financial support including a namingopportunity Stay tuned for further information

DOC = Doctors of Compassion wwwhumanism-in-medicineorg

Keep in TouchThanks for reading the printed version of DOC You also have the option of receivingDOC by e-mail Drop Kerry an email at kerrygold-foundationorg No need for anote ndash just put ldquoGo Greenrdquo and your name in the subject line and Kerry will do the rest

Visit our Facebook pageto see whatrsquos new in medical education compassionate care and GoldFoundation programs around the country and around the world Simplygo to wwwbitlyGoldFacebook

Follow us on TwitterGoldCareInMed where we share links to interesting articles about thedoctor-patient relationship and news about Gold Foundation awards andceremonies

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For enhanced content including links to articles and additional information

view the e-version of DOC at wwwhumanism-in-medicineorgDOC_ Fall_ 2012

ldquoMy husbands Humanism in

Medicine lapel pin recently broke

with the face of the pin separating

from the fastener Is there any way to

replace the pinrdquo - M

ldquoI would be happy to send him a new pin

Please reply with his name and address

and I will send it right out Thanks for

contacting usrdquo - Kerry APGF

ldquoThank you so much He is a 4th year

student and I believe he received the

pin at the White Coat Ceremony ndash he

was so upset when it broke I can ask

him for details if you need them - thus

far I was hoping to surprise him with

the replacementrdquo - M

ldquoNo thatrsquos fine Would you like me to

send it to your attention so that you can

surprise himrdquo - Kerry APGF

ldquoThat would be fantastic thanks

Ive made a small donation to the

foundation to express my gratitude

not only for the replacement pin but

for the work you dordquo - M

The value of a Lapel PinA recent exchange with APGF

If your ldquoHumanism inMedicinerdquo lapel pin is lostor broken wersquod be happy to replace itContact iangold-foundationorg and let us know when and where you receivedyour original pin and wersquoll send you a new one Wear it always and wear it well

DOC = Doctors of Compassion

The Silent World of Doctor and Patient Jay Katz Baltimore MD The Johns Hopkins University Press 2002In looking at the doctor-patient decision-making process physician and law professor Jay Katz examines the time-honored belief in the virtue of silent care and patient compliance Historically the doctor-patient relationship has been based on a one-way trustmdashdespite recent judicial attemptsto give patients a greater voice through the doctrine of informed consent Katz criticizes doctors for encouraging pa-tients to relinquish their autonomy demonstrates the detrimental effect their silence has on good patient care and advocates for a new informed dialogue that respects the rights and needs of both sides

The Human Side of Medicine Learning What Itrsquos Like to be

a Patient and What Itrsquos Like to be a Physician Larry SavettWestport CT Greenwood Publishing Group 2002This book presents case studies about what it is like to be a patient a day in the life of a physician the doctor-patient relationship and teaching the human side of medicine

When Doctors Become Patients Robert KlitzmanNew York NY Oxford University Press 2007 The purpose of this book is to illustrate the complicated lives of doctors when they become ill their emotions their need for balance and their identity The author successfully breaksdown the myth of invulnerability opens readers up to the preciousness of life and provides firsthand accounts of 48 doctors coping with their own mortality

The Arnold P Gold Foundation619 Palisade Avenue Englewood Cliffs NJ 07632

The Arnold P Gold Foundation Inc

Tel (201) 567-7999 Fax (201) 567-7880Email infogold-foundationorg

Website wwwhumanism-in-medicineorg

Board of TrusteesJordan J Cohen MD ChairmanRichard Levin MD PresidentCEONorman Seiden Vice ChairmanMyron Rosner Esq SecretaryJeffrey L Saltzer CPA Treasurer

Elaine AdlerJennifer Ashton MDBrian E Benson MDRobert M BerkowitzArnold P Gold MDChairman Emeritus

Sandra O Gold EdDJoshua E Hyman MDLisa Kravet EsqWilliam J LippmanMarsha Levine PhDHerbert R Mayer

Robert B Mellins MDMarc Nivet EdDRobert O OwensJohn W Rowe MD

Arthur H Rubenstein MBBChJonathan D SeeligMark Seiden

Samuel Silverstein MDMichael SonnenfeldtReed V Tuckson MDAbraham Verghese MDBarry C Waldorf Esq

Ronald A Arky MDHerman AronsonRADM Susan J

Blumenthal MD MPABenjamin S Carson MDRita Charon MD PhD

Carl EpsteinRuth L Fischbach PhDSteven K Grinspoon MDJerome E Groopman MD

Brett Harris EsqDavid C Leach MDSherwin B Nuland MDWilliam J Peace PhD

Rachel Naomi Remen MDSteven A Schroeder MDKenneth I Shine MDDavid T Stern MD PhDJ Robert Suriano PhDDaniel T Williams MD

Barbara PackerManaging DirectorCOO

Ann BruderDirector of Programs

Ian FinisterreProgram Associate

Jacqueline MintzExecutive Director

Gold Humanism Honor Society

Harriet TurnerProgram Associate

Gold Humanism Honor Society

Michele SilverProgram Assistant

Gold Humanism Honor Society

Robert GurmankinVP of Development

Jennifer MillerDirector of Communications

and Marketing

Kerry FordDevelopment Associate

Mary MeehanBookkeeper (Pro Bono)

Medical and Professional Advisory CouncilNorma E Wagoner PhD Chair

Staff