Recently, The Arnold P. Gold Foundation announced that membership in the Gold Humanism Honor Society (GHHS) will now appear on Electronic Residency Application Service applications for residency. This news was met with excitement, suggesting that this change would allow for the more careful selection of humanistic physicians into residency programs. Yet, on closer examination, there are reasons for concern. Unlike honor societies based on merit judged objectively using data on academic performance, entry into the Gold Foundation, according to the GHHS Chapter Toolkit, is to be judged using a validated survey made up of 6 questions that is completed by peers.
The results are meant to indicate which of one's peers ought to be inducted into the yearly cohort of the GHHS. While this methodology is not in and of itself troubling, there is an important caveat within the chapter toolkit that presents reason for serious concern. Section 2C of the March 2015 edition of the GHHS Chapter Toolkit states, “Medical school chapters may induct up to 15% of the medical student class, 2 faculty members, and 6 residents selected by students . . .” Later, “students should be humanistic exemplars . . . and should range from 10%–15% of the class.” It is precisely here, where humanism is rationed, that there is cause for concern.
Humanism, as conceived by philosophers and physicians, is a quality that every good physician should possess. Humanism should never be a trait limited to a few select individuals; rather it is an ideal to which all people, and physicians in particular, must aspire. To engage in rationing humanism is an ironic misrepresentation of humanism itself. Humanism is not typified by the “best listening skills”1 or an “exceptional interest in service”1—these are external manifestations of an underlying attitude. No survey instrument could properly assess a physician's inner desire to serve as a beacon of hope for his patient, nor should such a survey serve as the basis for rationing humanism by bestowing the label “humanistic physician” on a limited number of individuals.
Humanism in medicine is attempting to care and be present for each patient, in spite of the severity of an illness or station in life, regardless of whether one succeeds or receives acclaim from one's peers. Humanism is often about the small moments and personal connections with one's patients. Humanism is about connections to other people that are by definition often unknowable to third parties. Sadly, in an era in which everything (including emotions) must be quantified to exist, it seems humanism has become another victim.
The Association of American Medical Colleges, the Gold Foundation, medical students, and medical schools ought to reverse the push by any institution that seeks to limit the mantel of humanism to a select few by removing the cap on those who can join the GHHS. The Gold Foundation has developed an excellent program in GHHS. Now it ought to allow the GHHS to flourish.
