A Conversation with Picker Award Winner Dr. Arnold Gold

Dr. Gold received the Lifetime Achievement Award from the Child Neurology Center in 2005 and an Honorary Doctorate of Humane Letters degree from the Mount Sinai School of Medicine in 2008. 

Dr. Gold, you have a stunning resume and a long, long list of publications, honors and awards. But what was it that piqued your interest in your foundation’s mission of preserving the tradition of the caring physician and advancing humanism in medicine? And how long was it from the concept to the concrete? 

So how did an academic and a clinician become an activist? In the 1980s I became concerned about certain trends in medicine. This was an exciting time for science and technology, and it was apparent that our fledgling physicians were becoming enamored with that aspect of medicine. Additional pressures, including limited time for examining patients, plus the other stresses of medical economics, distanced doctors from their patients. Because my patients had taught me so much about the power of relationships and the importance of building trust and respect between doctor and patient, I could not accept a culture in which patients were referred to as “the tumor in room 202.” 

I often expressed my concern about the general decline in the quality and importance of what we called “bedside manner” to Sandra (my friend, critic and live-in therapist). Tired of hearing my lament, she admonished me to “do something about it or stop complaining.” 

I couldn’t resist the impulse to insure that future doctors would have the same meaningful patient-doctor relationships that I have so enjoyed in my practice. Those were the thoughts that propelled me to accept Sandra’s challenge and enlist her participation in the process. Literally in one day in the fall of 1988, I developed a foundation board. It included colleagues from Columbia and community activists. I was gratified that the dean agreed that Columbia College of Physicians and Surgeons would be the laboratory for the foundation’s programs. 

Determining how a small group of professionals and concerned lay leaders could influence the culture of medicine was not so simple. The board deliberated for about 18 months to develop our mission and a set of strategies to guide our work. We determined that we wanted to improve patient care by reemphasizing the humane characteristics of the doctor-patient relationship we believe are essential for good medical practice. 

The founding board, while striving for the ultimate imperative of delivering better patient care, focused on the medical education arena, where they believed the foundation could make a difference by influencing new and practicing physicians and developing collaborative partnerships. 

The Gold Foundation began with an idea that physicians-in-training had to acquire both a burgeoning amount of scientific and technical knowledge and the habit of humanism to best serve the interests of patients and to become effective healers. We concentrated our efforts on fostering the values and behaviors that reflect humanism—such traits as empathy, respect, caring, integrity and service—not only toward patients and their families, but toward everyone on the health care team, 360-degree Relationship-Centered Care. We knew we could not necessarily change people, but we could change expectations and behaviors. 

Our first formal and scalable program began at Columbia in 1991 with an award for humanism in medicine given to a graduating medical student and a role-model faculty member. The White Coat Ceremony was introduced in 1993, and we were off and running. 

Today, our premise is simple: The house of medicine stands on two pillars: humanism and science. Each must be equally strong to keep the house secure. Effective and empathic communication and building trusting relationships with patients must be taught and assessed as a core competency of doctoring, and thus be perceived to be as relevant as the science and technology. 

Do you feel that these two pillars of the medical profession—what one might even call the basic principles–have lost some of their stature as medicine has advanced over the past 60 years? To what do you attribute this decline in civility? 

When I began my medical career, for many serious, life-threatening illnesses there simply were no cures. All we had in our black bags was the ability to care. Today, with our burgeoning science and technology, we have made great progress, but “cure” has overtaken “care” as the primary objective in healthcare. I applaud the miraculous scientific advances of the past half-century. 

But I agree that we have lost something important—vital, even—in our modern medicine with its medical cures and medical perils. And it is more than civility. I maintain that with science alone, we cannot provide the best healthcare possible, nor achieve the best healthcare outcomes, or fulfill the social contract that medicine has with society. We can cite all of the reasons—medicine as profit-driven rather than service-driven; the marketing behavior of the pharmaceutical industry; the demands of managed care with its limited time for communication and relationship-building; the threats of litigation pitting the doctor and patient on opposite sides, etc.—all forces of our contemporary healthcare system that have weakened the pillar of humanism. But though they are real, they are not—and cannot be allowed to become—excuses for inaction. 

I know there is no quick fix, and no one program or ritual can sustain the inclination toward humanistic care. But our mutual goal—both the public and the professional—must be to build a paradigm for healthcare that embodies the dual standards of excellence in science and excellence in patient-centered care. 

Your work focuses on children and neurology. In fact, the Dr. Arnold P. Gold Child Neurology Center at the Morgan Stanley Children’s Hospital of New York-Presbyterian Hospital, Columbia University Medical Center, was dedicated and opened in 2003. What drew you to these fields? 

Though my parents were both lawyers, I set my heart and mind on becoming a doctor as a young boy. My family played an early role in developing my professional persona. My mother taught me the importance of perseverance and intellectual excellence. My father was known for his humanism and sensitivity. 

Beginning with my parents, at each juncture of my journey, I found the essential mentor or friend who nourished and guided me. 

Of my teachers, I especially remember Dr. Margaret Smith at Charity Hospital in New Orleans. My internship at Tulane under her guidance was pivotal in shaping my career. When I entered medicine, the formal curriculum was rigorous, but not nearly as voluminous as it is now. At that time, caring for the sick and dying was often a primary objective, since cures for many diseases were unattainable. 

In the hot New Orleans summer of 1954, I was working literally around the clock at Charity Hospital. It was at the height of the polio epidemic, and we had 35 children in iron lungs requiring constant attention. Wards were not air-conditioned, and electricity was not dependable. Like my mentor, Dr. Margaret Smith, I slept, ate and stayed at the side of my patients. Her behavior was my curricula; her values informed my own. There were no mixed messages or competing values, as there are today. Doctors did what their attendings modeled. Meeting the needs of patients—whatever the personal cost—was the norm. Dr. Margaret Smith, with dedication, inspiration and scientific excellence, led me into the world of clinical pediatrics. 

Serendipity plays such an important role in life. When I came to Babies Hospital at Columbia in 1957, I had planned to go to Johns Hopkins to be a pediatric endocrinologist. At Columbia, I met my friend and a founding trustee of the Gold Foundation, Robert Mellins, who was then a pediatric resident. Bob convinced me to experience a new field called child neurology and led me to one of its founders, Dr. Sidney Carter. One evening I attended rounds with Dr. Carter, and the rest is history. 

Sid was the ultimate and consummate role model–mentor. A brilliant clinician, Sid coupled scientific and diagnostic acumen with humanistic care at the bedside. Under his influence, I decided to become a child neurologist in spite of my uncle’s warning that “this new field will never give you a single patient.” Throughout my more than 50 years as a physician, I have tried to emulate this extraordinary man and to follow his example. 

As I reflect on the experiences that have taught me the most about doctoring, I realized that my patient-centered practice was born from those early and essential role-model mentors, the explicit and implicit expectations that patients come first and foremost. 

What would you say to today’s medical students to remind them of what medicine really is: caring for other people and trying to cure their ills? Can patient-centeredness be taught? 

My entrance into medical school held the promise of new discovery. But from experience I learned that each discovery is replaced by the next, that papers and books “age out” and that the single most important aspect of my life has been the relationships I have enjoyed. 

Here’s what I tell medical students: While the textbook knowledge you have acquired over the years is certain to change, your raison d’être, if you will, will not. What will not change—what must not change—is your conviction that good medical practice is, and should always be, relationship-centered and humanistic. The realities of illness, death and dying require those skills so perfected by your predecessors—those who had less to offer scientifically, but who knew how to communicate compassionately and effectively with patients. 

Seek to emulate those doctors who display technical competence, compassion, empathy and trust. Mostly, you can choose the doctor you want to be. 

You and your wife, who founded the Arnold P. Gold Foundation with you, must have hope for the future of medicine, else you would not be working so hard to disseminate your own beliefs. Do you see progress? regress? no change in the status quo?  

When we started the Gold Foundation, we felt a bit like the proverbial wanderers in the desert in search of an oasis. “Humanism in medicine” was an amorphous concept, one that few people could wrap their arms around. No one was talking about humanism, and we felt very much out there, on the fringe. But we were encouraged by a Buddhist notion: “Not all who wander are lost.” 

Now here we are, more than two decades later, and the landscape has changed. Humanism and professionalism are no longer an inspiring indulgence. Certification requirements instituted by the U.S. medical licensure agencies stipulate that in order to graduate, medical students and residents will have to demonstrate humanistic and professional behaviors as part of their core medical competencies. And we are beginning to see this same requirement for recertification of doctors in practice. 

So we are optimistic . . . and hopeful. There’s no denying that we’ve left the desert. But we must also remain vigilant to insure that relationships and human beings remain at the center of any healthcare interaction.