To the Editor:
The results of the semistructured interviews of colleague-nominated humanistic academic surgeons conducted by Swendiman and colleagues were highly interesting. They identified 3 attitudes and 5 habits as key factors in sustaining humanism.1 However, I found the authors’ comparisons between humanistic surgeons and internal medicine faculty a bit weak considering the limitations of qualitative research and the small samples studied (n = 10 and n = 16).1,2 I agree with the authors that high workloads and prevalent burnout can erode humanism, but this equation works no less powerfully in the opposite direction. Humanistic care affords satisfying experiences that constitute a strong antidote against burnout.3 I see no reason for a difference in humanistic attitudes and habits between different specialties. The authors’ important insights taken with my and others’ observations1–5 culminate in 3 quintessential themes of sustained humanistic practice:
First, the humanistic clinician has the ingrained belief that only the combination of knowledge, skills, evidence-based decision making, and patient-centered care that emphasizes recognizing the patient as an individual person and providing empathy and support can result in healing. These two elements are inseparable, two sides of the same coin.
Second, the humanistic clinician sincerely disregards all privileges (e.g., education, position, authority) to truly see himself or herself as a human being equal/similar to the patient in all but professional expertise. Respect and humility, listening and reacting, and sensing the situation from the patient’s point of view are directly derived from this view and are major harbingers of humanistic care.
Third, the humanistic clinician is curiosity driven. This applies to the clinical problem at hand but also to the patient’s identity, circumstances, and feelings, as well as to the clinician’s own behavior (reflection is inward-directed curiosity).3
Medical school admissions are still primarily based on grades and test scores. However, academically successful candidates are plentiful, allowing admission committees to increase the weight of character traits that can be developed, with appropriate medical education, into mature clinicians displaying all 3 themes of sustained humanistic practice.
Ami Schattner, MD
Professor of medicine, The Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel; [email protected]
1. Swendiman RA, Marcaccio CL, Han J, et al. Attitudes and habits of highly humanistic surgeons: A single-institution, mixed-methods study. Acad Med. 2019;94:1027–1032.
2. Chou CM, Kellom K, Shea JA. Attitudes and habits of highly humanistic physicians. Acad Med. 2014;89:1252–1258.
3. Schattner A. Curiosity. Are you curious enough to read on? J R Soc Med. 2015;108:160–164.
4. Churchill LR, Schenck D. Healing skills for medical practice. Ann Intern Med. 2008;149:720–724.
5. Schattner A. The silent dimension: Expressing humanism in each medical encounter. Arch Intern Med. 2009;169:1095–1099.