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Steve’s Classic Paper

The habit of humanism: A framework for making humanistic care a reflexive clinical skill. Miller SZ et al. Academic Medicine 1999;74(7):800-803.

Reviewed by Janet Serwint and Ken Roberts

The background
We highlight this 1999 article to remember the contributions of Steven Miller and Richard Sarkin, two past-presidents of COMSEP. In 1996, they had attended a meeting on Humanism in Medicine, sponsored by the Arnold Gold Foundation, and were inspired to propose a Traveling Fellows Program. They became the Foundation’s traveling fellows until their untimely deaths in a plane crash on October 19, 2004.

The article
Steve Miller and Hillary Schmidt describe a three component framework that serves as a foundation and moral compass for the practice of humanism. The first is to understand the perspectives of everyone involved: the patient, family and the health care provider. The second stresses reflection on how these perspectives converge or conflict. These two components are valuable in both patient care and personal relationships, especially when views conflict. The third component, however, may be the most poignant and powerful: Choose altruism.

This framework can help trainees-- and the rest of us-- make humanism part of daily practice. To ask the questions in every encounter (What are the perspectives of the patient and family and what is yours? How do the perspectives converge or conflict?) leads to reflection and insights. With repetition, this reflection can become an expected part of a review of a patient, similar to ensuring that vital signs are checked and the physical examination is complete.

Additional thoughts and the legacy
To make teaching the framework more effective with learners, we would add the value of thinking out loud when considering alternative perspectives, both to model the process and to invite thoughtful reflection. The word “habit” implies sufficient repetition to make the method reflexive but it also harkens to the word chosen by Steven Covey in his well-known book “Seven Habits of Highly Effective People.” It is notable, as we honor the memory of Steve Miller and Rich Sarkin, that Covey later added an eighth habit to the list: "Find your voice and inspire others to find theirs." Rich and Steve certainly did that; now it is up to us.

Editor’s note: This paper reminds of Rich and Steve’s work and legacy and allows everyone to learn from them. It also highlights the importance of scholarship – not for promotion or tenure or merit but, rather, for sharing ideas with a broad community and having a positive impact long after one’s passing (SLB).

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