By Dr Jane Lemaire
Fore word
For many years, Dr Jane Lemaire has been a trailblazer in the areas of doctor’s health and wellbeing. Dr Lemaire is the epitome of generosity and an inspiration for her peers across the world. She lives the philosophy of providence to all of us who try to make change in this area. Following her inspiring plenary at the International Conference on Physician health (ICPH), Úna from WRaP EM connected again with Dr. Lemaire, and discussed where humanity in our practice can take us.
A Vision for Humanity in Medicine.
- What does humanity in medicine mean?
Let’s take a moment to look at the definition of “humanity”.
The Collins English Dictionary defines humanity as “the quality of being kind, thoughtful, and sympathetic towards others”, and from the Oxford English Dictionary: “The quality of being kind to people and animals by making sure that they do not suffer more than is necessary”. It also adds, “Humanity is a word for the qualities that make us human, such as the ability to love and have compassion, be creative, and not be a robot or alien – the state of being a person rather than an animal, a machine, or a god”
Others define Humanity as a virtue, and one that is consistent across all cultures – linked with basic ethics of altruism derived from the human condition.
There is another definition of humanity: “The human race; human beings collectively”.
- So, what could humanity in medicine mean to you, Dr Lemaire?
Our role as physicians is to care for the sick, and to do so with humanity – as represented in all those definitions.
Within our profession, humanity is a necessary virtue where we:
– aim to alleviate or at least lessen suffering
-have kindness and compassion for people at their most vulnerable and often at their worst physically, emotionally, and cognitively
-and to enact the virtue of humanity without bias either innate or learned, conscious or unconscious.
Humanity in medicine compels us to adapt to the needs of every patient–person–human and to creatively overcome the substantive barriers to the delivery of care.
Humanity in medicine requires us to be healers in the true sense of the word – not robots or aliens whereby we reflexively and algorithmically apply evidence-based guidelines to the patient, but to consider that patient–person–human as an individual, and address their needs.
Humanity in medicine means – to not be a god, but to enter into a healing relationship with that patient–person–human, recognizing there are limits to the science, but also a broad scope and power of healing.
- What role could humanity in medicine play in sustaining and nurturing the medical workforce?
We can think of how our profession has evolved. In the early days, the doctor-patient relationship was simple. Only so much could be offered to ill patients and there was an acceptance of the ravages of illness, unanticipated tragedies and trauma, and the aging body. There were also traditional gendered roles – a physician devoted time to the profession, while others supported home and family life.
Advances in medical science engendered healthcare “systems”, disrupting the simplicity and autonomy of the doctor-patient relationship and creating workplace tensions often beyond the control of doctor and patient. Add in electronic health systems, and multiple administrative tasks that whittle away at time with patients. Add in profit driven models of health care – the business of medicine rather than the fundamental right to healthcare. All threats to humanity in medicine.
Physicians began to experience occupational distress syndromes such as burnout, and increasing threats to mental health, with emotional distress through vicarious trauma, cumulative moral injury, and the burden of responsibility for medical errors, adverse events, and simply poor outcomes from bad disease.
What is lacking here? Humanity – not lacking from the individual physicians, but from within the cultures of the profession of medicine and healthcare systems. Yet somehow, the responsibility for all the system-level drivers of being unwell was placed firmly and solely on the shoulders of physicians – who were told to be grittier, more resilient, to better tend to their physical and mental health. And for physicians from diverse backgrounds and without traditional home supports, these challenges were amplified.
Mounting evidence supported that unwell physicians affect the healthcare systems – in terms of poor patient care and cost – and that most drivers of burnout originate from the work environment. Thus came the call to action: To recognize physician wellness as a missing quality indicator of health care systems, and that there is a shared responsibility to address physician wellness.
A system-level approach to physician wellness is humane – it should assure physicians the time, space, and energy to cultivate their own humanity, to not suffer unnecessarily in their work, to do their work well, to provide compassionate leadership, to “not be aliens, robots, animals, machines, or gods”, ….and to pay that humanity forward, to their patients, colleagues and loved ones… to experience the rewards and joy in medicine – and benefit the system in terms of patient care and cost.
4. Finally Dr Lemaire, what is your vision for a medical profession that embraces ‘Being Human’ in medicine?
My vision is for our profession to CARE FOR HUMANITY, and to do so with HUMANITY
To care for the human race – through our work in population health, community health, global health and public health. We are in the midst of two of the greatest global health crises we have ever faced during our lifetimes – the COVID-19 pandemic and climate change.
The common foundation for a medical profession that embraces the virtue of humanity in medicine is social and racial justice, through the principles of equity, diversity and inclusion.
There must be humanity in the provision of healthcare, without discrimination or bias based on ANY CAUSE. We can only truly care for our patients with humanity when we have empathy for their life situation – and patients can only feel understood when they see themselves represented within our ranks.
The pandemic has significantly set back generations of social and racial justice gains for all of humanity, and our profession is no exception – for example making it more challenging for physicians with caregiver responsibilities to complete their work duties and increased racially motivated attacks on physicians.
Humanity in the treatment of physicians must be viewed through a lens of diversity and inclusion – an understanding that we must go beyond “promoting” equity, diversity and inclusion in the physician workforce, to actively facilitating and adapting work environments for physicians from diverse backgrounds – and changing workplace models to accommodate that diversity. Patients may also benefit from more flexible care models.
To close, individual physicians, the profession of medicine, and healthcare systems, must COLLECTIVELY assume the responsibility for caring for humanity, and for ensuring humanity in the care of our patients, but also in the care of our physicians and the broader medical workforce.
As physicians, let us all be aware of, and accept our own humanity – and recognize the powerful influence and responsibility that we hold, as physicians and collectively as a profession, to enact the virtue of humanity for every person on this planet – including ourselves.
WRaP EM 