Humanism Improves Healthcare for Providers and Patients: Dr. Kathy Reeves, President and CEO of the Arnold P. Gold Foundation

Caleb Furnas: Hi, I'm Caleb Furnas, welcoming you to Raise the Line with Osmosis from Elsevier, an ongoing exploration about how to improve health and healthcare. 

I'm happy to do that today with Dr. Kathy Reeves, a pioneering leader of humanism and medical education who is currently president and CEO of the Arnold P. Gold Foundation. 

Before coming to the foundation in 2023, Dr. Reeves spent twenty years at the Lewis Katz School of Medicine at Temple University as a professor of pediatrics, founding director of the Center of Urban Bioethics and chair of the Department of Urban Health and Population Science. She was also the inaugural senior associate dean for the Office of Health Equity, Diversity and Inclusion. 

Thank you so much for joining us today, Dr. Reeves.

Dr. Kathy Reeves: Thank you for having me. I'm very excited to talk with you.

Caleb: Awesome. So I'd like to start with learning more about you and what first got you interested in medicine and particularly pediatrics.

Dr. Reeves: So I'm going to give an answer that I think a lot of medical students are afraid to give in their admissions interview, but I think it is the very best answer. I really wanted to spend my days helping people, and I really liked science. Those together made a clear path for me. 

I also grew up in a very small rural town, and I saw how important health was. I saw what it meant for people and families to have doctors and nurses who were accessible, who they trusted, who they thought were kind, and how it affected their well -being, and I also saw all the potential that exists when children are allowed to flourish and be healthy and have opportunities. So for those reasons, it just made perfect sense for me to really dedicate the gifts I have, the opportunities I have, to making the lives of children better.

Caleb: Amazing. I think that resonates with a lot of the students that listen to our podcast. So I mentioned earlier, you were the director of the Center for Urban Bioethics at Temple University before coming to the Gold Foundation. That might be a new specialty area for some of our listeners. Can you help us understand what urban bioethics is all about and what drew you to that field?

Dr. Reeves: Sure. So the basic tenet of urban bioethics is that health disparities are unethical. We as a society have become so desensitized to disparities. I was at Temple University for twenty years.  We say in Philadelphia, there can be a mass shooting every weekend in North Philadelphia, and it doesn't raise an eyebrow because we're desensitized.

I'm a pediatrician. I still work at St. Christopher's Hospital for Children. Children's Hospital of Philadelphia is right down the road. CHOP has eighteen or more pediatric allergists. St. Chris doesn't even have one full-time pediatric allergist. It's all about insurance and payer mix. It's an unethical thing to be treating patients differently because of their insurance. 

One example we used to give on talking about urban bioethics: if you happen to have a pandemic, and you had a number of people who were homeless or individuals who are not documented, how would you make sure that they had the access they needed to care and to vaccination? 

So it's taking the basic principles of bioethics and it's urbanizing them. As far as how I got into that, throughout my career, I saw how no matter how strong the science was, no matter if we knew which vaccine to give or which antibiotic to prescribe, it didn't matter if there was such disparity that people didn't trust or didn't have access. So shining a light on health disparities as unethical and as egregious seemed like a very appropriate thing to do.

Caleb: You and I both live in Philadelphia and what’s probably common to a lot of other medical schools across the country that are located in urban areas is these cities have suffered a ton economically in terms of systemic poverty and that kind of thing. 

When you're working with your students in medical school, how do you help them to see this sort of like bigger picture and help them to think of themselves as agents for change, given all the constraints around becoming a doctor? You know, picking a specialty that's going to help you pay off your loans or dealing with HMOs. How do you, as an educator, try to address these sorts of systemic challenges while helping these students get on with the practical job of learning to become a clinician?

Dr. Reeves: Well, I think there's a couple really important points that faculty who have the privilege of working with students really need to pay attention to. The very first and I think most important one is to recognize and nourish the amazing students that are coming into medical school. I've been on an admissions committee the whole twenty years I was at Temple. The students coming to medical school are amazing people who want to make the lives of other people better, who are smart, who are gifted, and who are hardworking. We have to make sure we help them stay that way, and not make it so that that becomes too hard, not make it so it's too exhausting to do that. And then we have taken all this energy and this amazing ability and help our students focus.

We understand our own identities. We understand our own experiences and they teach us a lot. But as physicians and as healthcare professionals, we have to be open to hearing other people's stories, we have to really try and understand where other people are coming from. You know, I'm a white woman from a small coal mining town in Pennsylvania and then I come to North Philadelphia and the only way I'm going to really learn about what it's like to be a young black man or a young mother who identifies as Hispanic who lives in North Philadelphia is to spend time with them. 

We will all form habits. I would say this to the students all the time. We can either do it intentionally or we can let it happen to us. So the advice I would have is understand how amazing the students are already -- we don't have to make them amazing -- and then give them opportunity to learn about the world and all the different people they're going to have the privilege of working with. They'll absorb that like a sponge. Then third, help them understand the real value of listening. Listening is more important than talking. For people who are really bright, it's important to develop an intentionality to not talking so that you can hear the stories people have to tell you. In those stories lies medicine.

Caleb: That's a great way to sort of think about medicine. I mean, from where we set off in the world of medical education, there's just such an emphasis on learning the preclinical science behind all this stuff that the humanist part obviously gets sort of short shrift as you describe. Dovetailing from that, can you tell us a little bit about your work at the Gold Foundation and maybe how it tries to emphasize the humanistic aspects of medical education?

Kathy: Sure. So I think it's really important that we understand that people are not dying in our hospitals today, or people aren't unhealthy, because we don't know the science. If COVID taught us nothing else, we can develop a vaccine that works completely differently than any vaccine we've ever had in the past in a year. But it doesn't matter if people don't trust us enough to get the vaccine. So humanism in healthcare is the vehicle to allow science to make an impact. Without humanism, science has no value and the more we advance our technology and medicine, the more at risk is humanism. Because we forget

that that person in front of us is a human who's lived this whole life, brings beliefs and context and fears and strengths, their own story to this relationship, to their lives and to their health. So humanism, from a 30,000-foot view, is that.

At the Gold Foundation, we really believe that there is science around humanism. We define humanism as healthcare that is trustworthy, where people feel safe, and where people feel like they are really cared for. There's more science in the value of those things than many of the things I learned almost thirty years ago when I was a pediatric resident. If I did some of the things that people told me were science back then, I would be committing malpractice. But it's always true that it’s better to make sure I take a moment before I walk into a room and assume that the person I'm going to see wants to be healthy or wants their child to be healthy, and then the first thing I say to them is not what's wrong, what's your problem, why are you here, but something that validates them.

I'm a hospitalist. I usually see people after they come up from the emergency room. If I just say, “Oh my gosh, you must be tired, that was really hard, your child's so lucky you're here with them” then the tension in the room just deflates. That's more valuable to them. That hasn't changed in thirty years and there is true science behind that. One of my favorite articles is a publication that has proven that it takes on average forty seconds to do what I just explained. Now everyone says you can't do humanism in healthcare because it takes too long, but it’s only forty seconds to change the dynamic. 

So humanism in healthcare is science. It is what is needed to change a broken healthcare system, I believe. And it's the only vehicle that's going to allow people to really benefit from all of the advances in medical science that we make on an even daily basis.

Caleb: On that note, can you tell us the origin story of the Gold Foundation? Because it overlaps nicely with this notion that the science was getting too much emphasis at the expense of these sort of human interactions and relationships.

Kathy: Sure. So Arnold P. Gold was, of course, a pediatrician. He was a pediatric neurologist at Columbia in New York City and Arnold's patients were everything to him. You know, MRIs weren't yet developed, CT scans were just starting and there was no electronic medical record. This is back in the 1980s. And so a lot of what Arnold could do, was all about your physical exam, it was all about the patient telling you their story, and it was all about Arnold supporting children and families through really difficult disease processes. 

He was rounding one day in the hospital with residents and students, and there was a patient, his name was Glenn, who was a young preadolescent boy who had a brain tumor, a glioblastoma. The residents were presenting Glenn's medical history to Arnold -- what medications he was on, all of that -- and Arnold listened. They knew all of the medications, all the side effects, all the studies. He said, “So tell me how the patient is doing. How are his siblings? How's everyone dealing?” And the students said, “Oh well, we don't know. We don't know if he has any siblings.” And Arnold says, “OK, so how are the parents?” And they said, “Well, we haven't really talked to the parents about how they're doing.” Arnold was a little frustrated. But then he said, “OK, so we're going to go in together and I'm going to show you how to have these conversations.” 

Now this is before the electronic medical record. Right now, students would walk around and they'd have every patient's name in front of them. And Arnold said, “What's his name?” And they didn't know his name. So he realized right then and there that entering medical school requires a commitment to humanism. He would talk about going to medical school graduations where students would take an oath, and he would often say, that's way too late. So he created something called the White Coat Ceremony, which really has very little to do with the white coat. But it is a ceremony now that's really present in pretty much every medical school across the country. People think of it as a right to passage to enter medical school. 

For Arnold, it's your chance to commit your entire medical career to humanism, and the reason he calls it a white coat ceremony is because during that ceremony, every medical student takes an oath that they will continue to practice humanistic care throughout their career, and for him, the white coat ceremony was merely a reminder that they took that oath from day one. So I think it's the only way to really create humanistic healthcare. It has to be longitudinal, it has to be iterative, it has to be throughout every part of our education and our practice. 

From there, Arnold built more programs including one that I'm sure most of the students have heard about: the Gold Humanism Honor Society. It recognizes the champions that are going to really change healthcare in a way to make even the systems more humanistic, to a number of other programs that help to make healthcare kinder, safer, and more trustworthy.

Caleb: What are you most bullish about as far as new developments in humanism and medical care? Like, what do you think has some of the best promise in the years moving forward?

Kathy: So I'm an academic at heart, I'm a researcher, I'm a practical person. We need to change the system so that humanism is the default. There are amazing clinicians out there that practice kind, safe, trustworthy care every day, and it exhausts them because the system isn't set up for that. The system isn't set up to be centered on making sure the patient trusts, making sure both the patient and the healthcare professional feel safe, and making sure that kindness is central. So we are creating something called human -centered spaces that is based on evidence we've seen in other areas. For instance, in K through twelve schools, we understand that life is hard and students have experienced a lot of trauma, especially in some of our urban spaces. 

I did this work in three elementary schools in North Philadelphia that were part of the Philadelphia School District. We created spaces where the teachers and all the adults in the building understood the impact of being a child in North Philadelphia. How does trauma affect us? And I don't just mean interpersonal trauma. I mean not having a stable caregiver, having people in your family that are suffering from substance use disorder, suffering child maltreatment, not having food, all of those things. And that changes us. That changes our physiology. In the same way, if people can feel safe and they can feel like they're really cared for, it can fix those physiologic changes. 

So we taught the teachers and the staff in those elementary schools how to help children who were suffering from trauma. It's a little bit like understanding if you're in a forest and a bear is chasing you, all you want to do is run, so your cortisol level is high. Well, these kids in North Philadelphia, their cortisol level is always high. So if someone bumps into them and they push back, that's an appropriate response. What we need to do as adults is not grab their arm, take them down to the principal's office and suspend them; we need to give them a glass of water, take them to a quiet space, sit with them and say, what happened to you today? 

That's what we need to do in healthcare. People come to appointments afraid. They bring their lives with them. They have cancer because they smoked too long. Nobody wants to be in that situation. Understanding that that's about trauma helps us. So, I say all this because we can go into clinical spaces, and we can teach physicians and nurses and all members of the healthcare team about the impact of trauma in people's lives. We can teach them the tools when someone is dysregulated, is afraid to change that. And then we can support the healthcare workers who are doing this in this very hard job so that they stay healthy. Then we're going to have people who trust healthcare more because the healthcare interaction is going to be centered on trust, kindness, and safety, not on efficiency and science.

Caleb: Do you think that the responsibility for providing a more patient -centered experience lies mostly with the front-line worker, with the insurer, with the hospital? Like, where do you see the bulk of this responsibility lying, given that it's obviously multi -factorial? 

Kathy: It's the system. It's the hospital. It's the payer. I am confident if we do this, we will save a lot of money. So I want to do this. We're going to pilot it. It's a very structured plan. We have three potential partners to do this and then we're going to measure if patients show up for appointments more often? Are members of the healthcare team less burned out? Do patients feel safer? Do patients trust more? Are they able to enact their healthcare plan more? Systems will save a ton of money if more patients show up for their appointments. I don't know how many times I sat in meetings and that was the biggest problem. They call it no-show rates. Payers are gonna really care if healthcare is more successful. 

So, I think our job is to prove to the decision makers that this matters and then have the payers say, ‘it's in our best interest as a business to make sure healthcare is kind, safe, and trustworthy’ because that's going to save them money. Payers are going to say, it's in our best interest to do that because people are going to be healthier. Health systems will say that because their healthcare team will have less burnout and moral injury. It is a science. So that's what I'm most excited about, is bringing the science of humanism into a clinical setting and proving that it makes people healthier, decreases healthcare professional burnout, and saves money.

Caleb: Amazing. Dr. Reeves. Thank you so much. I think this has been a really fascinating conversation and I hope something that a lot of our students can feel encouraged by. I really appreciate you sharing these stories and your experience doing this work.

Kathy: Well, thank you for what you do as well. I think for students to have a place to hear about opportunities, to hear what's happening, to have a voice is really valuable. So, thank you as well.

Caleb: Wonderful. Thank you again, Dr. Reeves. I'm Caleb Furnas. Thanks for checking out today's show. Remember to do your part to raise the line and strengthen the healthcare system. We are all in this together.