Leaders in Patient Experience: Sandra and Arnold P. Gold
By Barbara Sadick
By the early 1980s, phenomenal and critical advances had been made in medical technology. The CAT Scan, MRI, and other high tech diagnostic tools were becoming widely used, but something else was also happening. Medical students and residents had become so enamored of new and groundbreaking technology that a tendency to distance themselves from patients had gained momentum.
On rounds with medical students at the time, Dr. Arnold P. Gold, professor of clinical neurology and pediatrics at Columbia University’s College of Physicians and Surgeons, witnessed a disturbing incident. A child was being treated for a neuroblastoma, and one of the residents, who knew everything about the tumor, knew nothing about the child, not even his name. “This was a child,” Gold said, “but the resident referred to him by case and room number. I was furious. I chastised him, and told him he knew nothing about patients. I was deeply saddened by what I was seeing – this loss of caring.”
At about the same time, another incident occurred, exacerbating Gold’s concern. He and his wife and partner Sandra were at a dinner party with friends. One of the guests was recounting the experience of her recent operation, which had been successful, but she had nothing good to say about the doctor. That’s when the conversation stopped, and each of the guests took a turn telling her worst doctor story. “That was the most difficult night of my life,” Gold remembered.
One incident after the other magnifying a lack of empathy in medicine continued to bother Gold. He complained endlessly to Sandra, who finally had heard enough. She was the person listening to most of his complaints, but one day she told him to either do something about it or to just live with it. “That was a tactic,” she grinned. “Nothing is impossible, and if he wanted to do something about it, then he could.” And that’s when Arnold decided he was going to address how patient care was being practiced.
Arnold and Sandra Gold form a solid partnership both in marriage and in their mission to advance humanity in the practice of medicine. Together, they began 23 years ago to build a foundation that has become one of the foremost organizations advocating for the practice of humanistic medicine. Based in Englewood, New Jersey, the foundation has grown from a small group of local New York and New Jersey activists to a worldwide force and influence in medical education.
“Arnold and Sandra are an amazing team,” commented Dr. Maureen Strafford of Tufts University School of Medicine and a member of the Gold Foundation Advisory Council. “Arnold brings the academic end of medicine to this – he loves the world of medicine, and Sandra has a deep understanding of humanism both as a counselor and as an individual. Her commitment and involvement is very contagious. They have worked tirelessly to change the culture of medical schools by emphasizing humanistic principles.”
Humanistic medicine is a practice of medicine that emphasizes the relationship between doctor and patient, puts the patient at the core of the relationship, is respectful and compassionate, and first and foremost promises to do no harm. The concept is as ancient as the Hippocratic Oath, a pledge and rite of passage for physicians that dates back to the 5th century B.C. Today, some medical schools continue to use that oath, while others have abandoned it for more modern versions such as the Oath of Maimonides, the Lasagna Oath, and various other pledges to practice medicine in an ethical manner, embracing the use of science and technology on behalf of patients.
In 1988, Sandra and Arnold Gold committed themselves to the mission of spreading the call for doctors and other health care professionals to engage with their patients in a humane, caring, and scientifically solid manner – “to practice medicine that is as compassionate as it is cutting edge.” The next step was to find money to support such a venture.
Arnold Gold had successfully treated the eight-year old son of John Peace, a prominent advertising executive, in the early 1960s. The child had a spinal tumor, was in critical condition, and Arnold Gold helped to save his life. To show his gratitude, every Christmas Peace would give Arnold $25,000 to be used to do something good for children. Arnold thought that perhaps he would allow that $25,000 to be used to help get the new foundation off the ground. “I went to visit him and asked him if we could do that,” says Arnold, “but he said we couldn’t. Instead he gave us $50,000 to help us start, and he did that every year until he died.”
With Columbia’s medical school as a supportive partner, a board of trustees composed of friends, philanthropists, and outstanding, cutting-edge clinicians and scientists was formed. They deliberated for 1 ½ years before coordinating a program agenda. That time was instead spent brainstorming about the best ways to rebalance the idea so prevalent in 1988 that science was the most important ingredient of medicine. The foundation’s goal was not to diminish science, but to enhance and spread the practice of humanistic medicine. The Gold's believe that without a combination of the best of science and humanity, a student can never become a great doctor. The problem, though, was to figure out how the organization could inculcate medical students with a humanistic set of values – to be as compassionate at the bedside as they are scientifically excellent.
Understanding the importance of making a positive impact, the board spent the time needed to discuss ways in which cultures operate. Anthropological and sociological examples of the way in which newcomers and children adapt to cultures were reviewed. At Sandra’s suggestion, they set out to understand how rituals are used to clarify sets of values, how role models and mentors become leaders in the process, and how individuals are rewarded for good behavior. Because the foundation believes that medical students will do what they need to do to become doctors, the board decided the best time to begin to instill and perpetuate the tradition of the caring physician and emphasize the importance of the doctor-patient relationship was during the four years of medical school. An added advantage was that medical students could be tracked and evaluated to assess the effectiveness of programs.
“We knew that humanism in medicine was not much talked about,” said Sandra, “but when we looked at other cultures, we found that it was in the rituals that expectations became clarified, and we began to reward and recognize medical students and faculty for their excellence and compassion in medicine.” The first public action of the Gold Foundation was to create the Humanism Award to be given at commencement to doctors and students who best exemplify both clinical excellence and compassion in medicine. The goal was to make humanism so important and so prestigious that medical professionals would become inspired to work toward the recognition and its significant financial stipend, the largest of any award granted to a doctor or medical student at that time. Many recipients feel that this is like winning the Nobel Prize in humanistic patient care. The award is funded today in 90 medical schools, and is currently known as The Leonard Tow Humanism in Medicine Award.
The second initiative evolved out of a moment of realization. Arnold and Sandra were at a medical school graduation in the early 1990s. Standard practice was for the entire class to stand after receiving diplomas to recite the Hippocratic Oath or a variation on that oath. “As I heard the oath being recited,” says Arnold, “I said to Sandra – Sandra, this is four years too late. They should be taking this oath on the first day of medical school, not the last,” and thus was born the idea of the White Coat Ceremony.
The White Coat Ceremony is now one of the best known and widely practiced initiatives of The Gold Foundation. It gathers together witnesses from the old culture and representatives of the new. Deans make it a sacred moment, while speakers talk about the need for humanism in medicine. The ceremony’s purpose is to reinforce humanistic values. New medical students are cloaked for the first time, a symbol of entry into the world of medicine, and one of 43 different oaths now in use at various medical schools is taken. “The White Coat Ceremony is a powerful ritual,” says Strafford. “It’s moving and special and it resonates. It speaks to something young students want to hear, and many doctors are moved by it as well.”
The first ceremony was at Columbia’s medical school, after which additional initiations into the world of medicine were made possible by funding from the Robert Wood Johnson Foundation. Today, more than 90% of U.S. schools of medicine have a White Coat Ceremony at the start of the first year of medical school. Medical schools in the Netherlands, Israel, and others in Japan, Lebanon, and Canada have embraced this tradition. This year, Quesqueya Medical School in Haiti is being funded by the Gold Foundation to have their first White Coat Ceremony. “As far as we know, no school has discontinued a White Coat Ceremony once it has been initiated by a grant from the Gold Foundation,” says Arnold. And to reinforce the oath, it’s now taken again at the end of the second year of medical school at The Student Clinician Ceremony. During this ceremony, also created by the foundation, students are extolled by their peers, and awards are given to residents to support and recognize humanistic students who are about to enter a heightened relationship with patients.
To support and nourish humanism in communities, The Gold Foundation created the first national medical honor society to have been formed since Alpha Omega Alpha was founded more than one hundred years ago. Members of the Gold Honor Society, named for the gold standard and not for Arnold and Sandra, are chosen by their peers for being caring, clinically excellent, compassionate, and smart. They are the doctors whose peers would trust them to care for a loved one.
Nominated and inducted into the society in 2007 during his fourth year as a medical student, Jonathan Amiel says that his medical school class nominated about 30-40 people who had been identified as being role models. Of those, 20-25 were chosen to be members of the society. Amiel, now 32 years old, is a psychiatrist working in a Columbia University community health clinic, a teacher, and an advisor to students on curriculum. “Humanism,” he says, “has become a tremendous movement in medicine, especially as everything becomes more standardized. I try to always be mindful of what my role in a patient’s life is, and I practice medicine in a way that takes into account a patient’s experience.”
Various other projects and programs are funded by The Gold Foundation to reinforce, spread, and encourage humanistic principles. “Arnold and Sandra have been laboring in the field,” says Strafford, “and they give away everything they get.” She says not only have they done a tremendous job in setting an example in what it means to be a humanist, they have changed the culture of many medical schools. “If you don’t care or feel compassion,” she says, “being a doctor is a really lousy job.”
Like Strafford, Elizabeth Gaufberg is a Gold Professor and Assistant Professor of Medicine and Psychiatry at Harvard University. She works on an experimental curriculum that restructures the third year of medical school for a small number of students by focusing on the patient experience. “The Gold Foundation is very supportive of innovative programs,” she says, “and very open to different perspectives. They are really cutting edge, and for us they have made educational interventions possible.”
With the foundation on solid footing, Arnold Gold stepped down as Chairman of the Board in 2006. The new chairman is Dr. Jordan Cohen, professor of medicine and public health at George Washington University, formerly President of the Association of American Medical Colleges, and an internist/nephrologist by training. He works hard to expand upon what he calls a “phenomenal contribution to medicine.” “The Golds,” he says, “have made an enormous impact on American medicine. They made a single-handed successful effort to get the foundation started and to gain support, and have produced miraculous programs in a short amount of time that have become real success stories”
Sandra Gold remains the President and CEO of the foundation, and is working tirelessly to set the groundwork for its future, and an expansion of its mission into the entire medical population.
“We want patients to receive the kind of care not only from their doctors, but from all health care professionals that is as compassionate as it is cutting edge,” she says. “All of our work is directed to the improvement of patient care and to the creation of a culture of medicine that says the patient experience should be caring and scientifically excellent. And I am going to say it again: If you are only a scientist, you are only half a doctor.”
To learn more about the Arnold P. Gold Foundation go to: http://humanism-in-medicine.org/
© Barbara Sadick, Association for Patient Experience
The first article in this series has been written by Barbara Sadick, Association member and freelance health writer. Based in New York City, Barbara’s clients include U.S. News & World Report, Healthline.com, The Commonwealth Fund, and Health Behavior News Service. In 2003, after the death of her brother from lymphoma, she began working as a freelance health advocate, researcher, and writer. Her personal experience has been supplemented with an MA in Health Advocacy from Sarah Lawrence College and an MS in Health and Behavior Studies from Columbia University. Available for freelance writing and research, Barbara can be reached at firstname.lastname@example.org.