In the Carnegie Foundation’s study, Educating Physicians: A Call for Reform of Medical Education and Residency (June 2010), the authors discuss what should be the “backbone of medical education”: “…the development of professional values, actions, and aspirations, building on an essential foundation of clinical competence, communication and interpersonal skills, ethical and legal understanding, and extending to aspirational goals in performance excellence, accountability, humanism, and altruism.”
Altruism? In CME, we concern ourselves with nearly every part of that overview, but I’ve never seen activities that focus on altruism, which Webster’s defines as “unselfish regard for or devotion to others.” Is there a place for fostering altruism in CME? Is it needed and viable in today’s environment? If we incorporate altruism into learning objectives, how would we measure it? And, not incidentally, who would fund an initiative dedicated to altruism?
Needed Now More Than Ever
It may seem strange even to raise the issue of altruism in these hard-edged times, when clinicians are so pressed to account for every minute with their patients that their visits are often dissatisfying for both parties. In fact, as the impact of the healthcare reform act is felt, doctors are likely to have even less time than they do now. Yet perhaps that’s why it may be worth the effort.
Most physicians will say they entered medicine because they wanted to help people; indeed, many regularly perform altruistic acts—in the form of free surgery in Haiti, for example, or charity care through clinics. However, substantial changes in our healthcare system and the doctor-patient relationship over the years have had an impact. There’s no return to the pre-Internet, pre-managed-care days when doctors were accustomed to being the decision-makers and the repositories of all medical knowledge, and their patients loved them for it. Constrained by time, reduced reimbursements, and the bureaucratic demands of insurers, and faced with patients whose Internet searches about their conditions may or may not have yielded constructive information, many physicians report feeling unappreciated, frustrated, and unhappy.
Under the circumstances, it may be hard for them to remember what brought them to medicine in the first place. Perhaps they need to be reminded. There is a considerable body of literature demonstrating various positive health outcomes when patients know their doctors care about them. Several studies have found that patients’ level of trust in their doctors determines whether they take their medication.
The doctor-patient relationship seems to be inextricably linked with the physician’s sense of professionalism and, yes, altruism. Interpersonal and communication skills and professionalism are among the core competencies required for maintenance of certification. Perhaps, then, it would be in the best interests of both doctors and patients to find a rigorous way to plan, carry out, and measure CME activities that grant credit for altruistic acts—for that surgery in Haiti, for that free clinic care. In other words, the CME community would encourage doctors to undertake important, patient-centered actions that make them feel good about being doctors, but that are increasingly difficult for them to do these days.
And perhaps, just perhaps, some forward-thinking grantors, who see the potential for greater patient adherence through the enhanced doctor-patient relationship that this altruism might stimulate, will underwrite such efforts.
Anne L. Finger, MA, is the executive vice president of Veritas Institute for Medical Education, Inc. Reach her at anne.finger@veritasime.com.
The opinions expressed are those of the author and do not constitute the views of Veritas Institute for Medical Education Inc.
