|Sandra and Arnold Gold and Richard and Jane Levin. COURTESY THE GOLD FOUNDATION|
It is perhaps verging by now on clichÃ© to say that medicine is all about relationships – after all, what in this world is not in the end all about relationships? – but still it is true.
It is about relationships between patients and their health care providers – doctors, yes, and also nurses, technicians, and everyone else who cares for them. It is about relationships between patients and their own bodies, and it is also about the relationships between the science that fuels new treatment methods but tends toward depersonalization and the humanism that is at the heart of medicine.
The Arnold P. Gold Foundation, a small organization in Englewood Cliffs founded by Dr. Arnold Gold and Dr. Sandra Gold 25 years ago, has devoted itself to ensuring that humanism remains vital as medicine advances, and it has had outsized successes. Its white coat ceremony, a ritual that reinforces the awesome (in its original sense), literally life-and-death responsibilities that medical students assume as their begin their studies, has been adopted by just about every medical school in the country.
Now, the foundation has welcomed a new president and CEO, Dr. Richard Levin, as it begins to navigate the changing landscape of American health care.
Levin brings an earned understanding of the arena with him. He is a cardiologist, scientist, and medical school administrator. He began his career with post-doctoral work at Cornell in vascular biology, and later established a National Institutes of Health-funded laboratory for cardiovascular research at NYU, where he became a full professor. He moved over to administration in the dean’s office there, and then became dean of the medical school at McGill University in Montreal. Why did he chose that path? “Because I didn’t see administration as the dark side, but as a means of changing the social, cultural, and academic dynamics – which were in desperate need of changing,” he said.
Originally a Jersey boy – he’s from Long Branch – and then a longtime New Yorker, he and his wife grew homesick. The Gold Foundation felt like home.
He already had an emotional connection to it, along with the clear ideological one.
His younger daughter, who is now a physician, was named to the Gold Humanism Honor Society when she was in medical school at Dartmouth, years before he began to work at the Gold Foundation. Each inductee is asked to name one mentor, and she named her father. The induction ceremony “was one of the most sublime moments I’ve ever experienced,” Levin said.
“I feel joyous to have landed this position,” he added. “This is not a usual foundation. The Golds put it together through magic.”
From the start, the foundation’s goal was to ensure that as medical science progressed, it did not replace the heart, the care, and the love – in other words, the soul – that always had characterized the practice of medicine. The Golds began by focusing on medical education, “so that explicitly, within the curriculum, it realized the function of humanism in health care,” Levin said. “Medical education in general is the old pot, the simmering stew, where new recipes for managing the rest of the system are invented on a regular basis.”
But resting on laurels rarely works. New challenges always present themselves.
He sees his task as “to preserve this miracle that Arnold and Sandra created, and that in 25 years really has changed medical education.” Now he wants to “expand the impact to a global one, not only to focus on physicians but also on the rest of the health care team. Patients experience health care without necessarily defining who is delivering it. They just know that they’re there, and they’re not necessarily happy, so everyone from the nurse practitioner to the medical technician to the office staff – everyone who comes into contact with the patient – has to be imbued with humanist principles.”
Some history is in order.
“A force arose with the advent of the technological era, which we could peg to somewhere between the 1970s and early 80s, when the CAT scan and MRI were invented,” Levin said. “These two machines, and the advancement of molecular biology, have given us the first opportunity to understand the fine-grained detail of many diseases. It’s given physicians a new frontier. It was unbelievably exciting.
Still, he said, “the pendulum has swung from the 2,500-year-old Western tradition, starting with Hippocrates, based on patient-centered understanding, to a technology-centered field that began to lack the characteristics that mark humanism.
“We’re not Luddites,” he continued. “We do not jettison the wonders of the genomic age.”
Ironically enough, he said, the increasing scientific nature of medicine “requires even greater intimacy between the health worker and the patient. It’s not as much about what disease may have befallen the patient as what genomic characteristics made the patient get this disease.
“It works better if humanism is the constant partner.”
Although the Gold Foundation is not an explicitly Jewish organization, “the Golds represent the blossoming out of Judaism of the ethical tradition of the faith,” Levin said, quoting the Talmud: “‘He who saves one life saves the entire world.'”
Sandra Gold, who will remain at the foundation as a counselor to the president, is enormously excited about the future.
“We’re just starting a research institute, and it will be remarkable,” she said. It will have two major thrusts. First, it will be a clearinghouse, a place providing easy access to information and data about humanism and professionalism. “We hope that policy makers as well as professionals and health care workers will use it,” she said; hard data about the effect of humanism on healing will be useful for public discourse.
“There’s more talk about the cost of care than the quality of care,” she said.
“The other thrust is to support and encourage the development of instruments to measure humanism,” she continued. “To help researchers understand what’s happening, so they don’t constantly have to reinvent the wheel.”
She is thrilled about Richard Levin.
“What I was looking for was a person with big ideas and a fire in the belly. Someone with lots of energy and passion. I wanted someone passionate about compassion. I believe we found him.”
She is firm that her leaving the presidency is not to be called “stepping down.” Instead, “the foundation is transitioning from a founder organization to the next generation of leadership,” she said. “The work not only will continue but be enhanced and expanded with new eyes, new competencies, and new experiences.
“I think that by bringing in Rich we have the assurance that the work I’ve spent 25 years leading will continue, with even greater energy and innovation and wisdom.
“There never will be a time when we can sit back and relax our guard. The tendency is for people to look at aspects of care that are very measurable, but the building of relationships is something that you benefit frtom enormously. Humanistic patient care and relationship-centered focus isn’t a nice option. It’s a requirement.
“I’m very optimistic that we will are going to be bigger and better than ever,” she said.
Arnold Gold is equally excited about Levin. “The Gold Foundation recognizes that both cutting edge science and caring relationships are essential for the best health care outcomes,” he said. “Along with all of his many talents, Dr. Richard Levin is devoted to that ideal, and to patient-centered care.
“We have found the perfect leader to pursue our mission!”