Caring and Curing
Miryam Z. Wahrman, Ph.D.
Is the doctor's "house call" only a distant memory, or can it be revived to assist in training better doctors of tomorrow? Can medical students be educated in the art of compassionate patient care? Those are some of the questions being addressed by an ambitious and idealistic Englewood couple. On a tree and mansion-lined street in Englewood, NJ sits the house of Drs. Arnold and Sandra Gold. It is not a typical Englewood home, as it serves as the headquarters for the Arnold P. Gold Foundation, a nonprofit organization founded by Arnold and Sandra Gold in 1988, to foster compassion in the doctor/patient relationship.
Why is compassion in medicine so important? Many can recount experiences with the medical profession which were less than compassionate. One woman recalls being instructed to undress her baby in the pediatrician's office. Forty-five minutes later, she recalls, she and her shivering baby had still not been seen or even told how much longer the wait would be. A male patient who was hospitalized was appalled when he was awakened in the middle of the night so the intern on duty could practice a rectal examination, which was not warranted by that patient's condition. And most patients have experienced the "office shuffle", where a patient is moved from one room to another only to be kept waiting in various stages of undress.
Gold Foundation Web Page
"Every person is entitled to be treated by a physician who is scientifically excellent, technically competent and compassionate in patient care," states the Gold Foundation web page. The website, which can be accessed at www.humanism-in-medicine.org describes some of the programs of the foundation, including grants awarded, "white-coat" ceremonies, and commencement awards for medical students and faculty. The website also provides a useful service to the medical community, as a resource on humanism and a forum for discussion of patient care.
A novel aspect of the website is a daily column called "The Big Picture", which consists of daily messages to provide "inspiration and respite from the rigors of work and study...stories, poems, essays, memoirs, anecdotes, thoughts and words of wisdom and encouragement by ...writers in the field of medicine." Authors recently showcased in this forum include Hippocrates, medical student Janak Acharya, doctor and humorist Patch Adams, and poet Emily Dickinson. A recent quote from Rabbi Mordecai Schnaidman published on the site declares, in the spirit of the Gold Foundation, "...we urge you not only to reach for the stars in your scientific and medical endeavors, but at the same time to make every effort to become fine human beings, Menschen, as people of character are called in Yiddish." All quotes and writings are accompanied by an eclectic selection of art masterpieces.
Another useful feature of the site is a guide to medical schools and programs in the United States which support humanism in medicine. Each program is ranked according its level of focus on humanism, compassion and ethics in its curriculum.
Drs. Arnold and Sandra Gold
Arnold Gold has worked as a Pediatric Neurologist at Columbia-Presbyterian Medical Center for over 30 years. His experiences treating children who were seriously ill and relating to their often distraught families led to his quest for more compassionate medicine. The Gold Foundation started out as a small undertaking - it began with a donation from the grateful father of one of Arnold Gold's young patients. The early activities of the foundation were carried out in the corner of the Gold family room. Sandra Gold, who has a doctorate in Counseling, decided to volunteer her time to foster the goals of the new foundation. (She is a veteran volunteer and community leader, and has served - among other roles - as President of the Jewish Community Center on the Palisades in Tenafly, NJ, and Vice President of the United Jewish Community of Bergen County.) Now, only ten years since its inception, the foundation has attracted the attention and support of hundreds of donors and scores of medical schools in the U.S. and Israel.
The foundation has grown to the point where the activities of the foundation have more than filled that original room with office equipment and piles of relevant materials. In fact, the work regularly spills over into the parlor, living room and dining room of the Gold home. "I have to clear the table every Friday for Shabbos dinner", commented Sandra, as she gestured towards her traditional dining room whose table is laden with piles of foundation work. "This is where I do most of my work".
White Coat Ceremonies
One of the first activities of the foundation involved introducing the "White Coat Ceremony" for entering medical students. In this ceremony new medical students take the Hippocratic oath and are inducted into the medical community by being "cloaked" in the traditional white coats of their profession. The Oath of Hippocrates was written in ancient Greece some 2,400 years ago. It states that the physician pledges to work for the good of his patient. "...That into whatsoever house I shall enter, it shall be for the good of the sick to the utmost of my power, holding myself far aloof from wrong, from corruption, from the tempting of others to vice..." This experience helps entering students recognize and appreciate their responsibility to their patients and to ethical behavior in their profession. In traditional medical curricula the Hippocratic oath is not taken until the end of four years of medical school, when students are about to embark on their practice of medicine.
"The foundation focuses on the training period from the first day through the residency years." explained Sandra Gold. "In 1993 we held our first White Coat Ceremony. From the very first moment in training the students can understand the important role of the doctor in the life of patients." She explained that the Oath of Hippocrates is the way to begin medical school, as well as the way to make the transition from medical school to becoming a practicing physician.
From its beginnings in one school in 1993, now more than a hundred medical schools in the U.S. and several in Israel have adopted the White Coat Ceremony for entering students. In addition, Sandra reported that, following their model, more than 85% of medical schools in the U.S. have similar ceremonies for students. Medical schools in Israel are also participating in the program. "Some schools in Israel set a high priority in creating doctors as caregivers," Sandra continued. "The Ben Gurion University Goldman School of Medicine is one example of such a program. They set a very emphasized priority on caregiving."
House calls revived
Another type of program being supported by the foundation is the Home Visit Program. Pilot-tested in the University of Virginia, the program sends teams of young doctors into the homes of patients. The visiting doctors are able to gather pertinent information about living conditions which can dramatically affect the health of the patient. For instance, in one home visit the team discovered that a newborn infant was being kept in a trailer home which reached a blazing 110 degrees in the summertime heat. Another visit revealed that a nebulizer provided for an asthmatic child was not usable in the home of the patient, since there were no three prong outlets in the home. While the Home Visit Program is limited in scope and won't provide most patients with a more convenient way to see a doctor, it does provide doctors in training with insight into their patients' lives. "Once you've been a guest in a patient's home you never think of them the same way again," explained Sandra.
Grants and Awards
Part of the process of producing caring physicians is to institute a reward system which recognizes the importance of the humanistic approach to medicine. The Gold Foundation supports annual awards for compassionate medical students. Other activities supported by the foundation include assistant and associate professorship grants for doctor/teacher role models, student summer fellowships for community health research, research into medical student's attitudes toward humanism, and sponsorship of national symposia on humanism in medical education.
Caring and Curing
The Gold Foundation has not taken particular positions with regard to ethical issues in medicine. Sandra explained, "Our job is to sensitize and raise consciousness to the importance of humanism with regard to how these issues affect patients." Student and faculty discussions and forums on ethical issues are supported by the foundation.
Dr. Arnold Gold explained how he and his wife work as a team. "It's a passion that we both have." "The Foundation is our attempt to emphasize the importance of being compassionate and humanistic, which is basically a Jewish concept."
The Golds have made it their lives' work to improve the level of caring in the medical profession. In the words of Dr. Arnold Gold, "Caring plays an important role in curing." They have communicated this message of caring to many through their dedication to the ideals and goals of the foundation.
Arnold summed up, "Certain persons are born with compassion. But in many cases humanism is developed, often by example, as well as with active programs." Drs. Arnold and Sandra Gold have been and continue to be role models and examples of humanism and caring. The Gold Foundation provides programs to train tomorrow's physicians. This will undoubtably impact on the compassionate practice of medicine for many years to come.
The Arnold P. Gold Foundation can be reached at (201) 567-4930. Their website can be accessed at www.humanism-in-medicine.org.
Dr. Miryam Z. Wahrman is Professor of Biology and Director of General Education at William Paterson University in Wayne, NJ.