Humanism in medicine is an essential component of quality healthcare. Humanistic healthcare is rooted in kindness, safety, and trust and emphasizes the dignity of all people. Important components of such care include a patient-centered focus, empathy through understanding the experiences of patients and practitioners, and scientific advancement to improve patient health. Humanistic care requires collaborative teamwork with a respectful and compassionate relationship between physicians, healthcare team members, and patients. Research indicates that humanistic care leads to improved health outcomes, treatment adherence, and patient satisfaction. However, sustaining humanistic care is vulnerable to various factors, individual and systemic, such as prejudice based on race, ethnicity, or religion as well as our response, as healthcare practitioners and leaders, to geopolitical events.
Challenges to Humanistic Care and Scientific Advancement
One current challenge to humanistic care for healthcare systems, both in the U.S. and abroad, has been the surge of antisemitism in medicine since the October 7, 2023 Hamas terrorist attack. Survey studies found that roughly 40% of US Jewish-identifying healthcare professionals experienced antisemitism in their professional or academic environment prior to compared to 88.4% after October 7, 2023. Medical publications about antisemitism increased 10-fold from 2000 to 2023, indicating a growing acknowledgment of antisemitism but also the inclusion of antisemitic tropes, false accusations, and conspiracy theories within the biomedical literature. Social media analysis similarly demonstrated a 1.9 to 3.6-fold increase in antisemitic social media posts after October 7, 2023 among American healthcare professionals. The surge of antisemitism in medicine is also an international issue, especially in Canada, the UK, and Australia.
These findings raise concern given that unprofessional behavior among healthcare professionals is associated with negative impacts on clinical and workplace performance, quality of care, and patient safety. Antisemitism within healthcare erodes its humanism by creating divisive, even hostile work and learning environments (which can violate Title VI of the Civil Rights Act), impeding collaboration and potentially harming patients. Congressional investigations have been launched due to reports of antisemitic incidents at medical schools. Shouts of “Long live the intifada” and “We don’t want no Zionists here” during protests at hospitals undermine healthcare team dynamics, do not promote a safe, welcoming, healing space for patients and their families, and may impact patient treatment due to “sick-outs” within such protests. In a recent example with serious risk to patient care, two nurses in Australia were suspended and are being investigated for stating at their Sydney hospital that they would not treat and would kill Israeli patients.
Antisemitism in medicine also manifests as exclusion of Israeli academics, which contradicts humanistic care by hindering scientific research aimed at improving the human condition. Academic and medical boycotts violate core values of academia by impeding shared scholarship and expertise and may prevent innovations resulting from such collaborations. Such discriminatory boycott practices internationally include ending scientific collaborations, canceling conference invitations, and negatively impacting journal submissions and academic appointments, and thus, have been denounced. Most recently, a Grand Rounds presentation by an Israeli physician-academic was canceled by the University of Maryland School of Medicine Department of Surgery, and another cancellation attempted at the Ophthalmic Society of South Africa. Such boycotts deny the humanism inherent in the Israeli healthcare system and prevent shared knowledge, cross-cultural training, and patient benefit.
Preserving Humanistic Care
The opportunity for author Seth Cohen to observe and participate in patient care In Israel in the difficult circumstances of a post-Oct 7 world brought keen insights into preserving humanism in healthcare. It was also an opportunity to see true narrative in action, specifically, the typically diverse healthcare teams, both ethnically and religiously, continuing to work effectively to provide compassionate care during a time of geopolitical conflict.
Despite potential differences in background and opinion, maintaining professional behavior and remaining patient-focused was necessary to address the massive challenges of significant patient volume, mental health burden, and risk to healthcare team cohesion. To reduce any potential division among healthcare teams of Jews, Muslims, Christians, and Druze, emergency department leadership at Soroka Medical Center explained the policy that “What happens outside these walls does not enter the hospital ” and that there are no enemies in medicine. The goal was to preserve a trusting environment where all patients, Jews, Muslims, Christians, Druze, or Bedouins, were and are treated with sensitivity and empathy, upholding the dignity of the patient. Hospital directors at Alyn Hospital provided clear instruction on acceptable speech and behavior (i.e., respectful discourse), and when needed, disciplinary actions did occur. During an inpatient consult at Rabin Medical Center involving author SC, two Jewish physicians, and two Arab speech-language pathologists, no one discussed politics or personal opinions but only how to help the patient.
The importance of empathy and supporting one’s colleagues as an essential part of patient care was evident during SC’s visit to Soroka Medical Center. 676 casualties were treated while under repeated rocket attacks in the first 24 hours after the attack. A collaborative, team-oriented effort followed with night shift staff assisting the day shift, other medical centers sending 28 nurses and 18 physicians, and social workers helping families locate loved ones. Daycare centers were opened to care for the hospital staff’s children. Resilience teams supported clinicians who were exposed to traumatic stress, suffering, distress, and grief. Healthcare practitioners across different backgrounds and religious beliefs also volunteered together outside the hospital, strengthening their shared sense of purpose and fostering mutual respect and understanding.
Collaborative educational and patient care initiatives, such as Operating Together, where Palestinian and Israeli trauma care practitioners learn together, and Save A Child’s Heart, which has treated over 7000 children from 70 countries with congenital and rheumatic heart disease, persisted despite heightened tensions. Hebrew University of Jerusalem continues its collaborative education of over 23,000 students including 2,400 international students from 90 countries and has over 10,000 patents, bringing global benefit to people regardless of identity, politics, or country of origin, a core component of humanistic care.
Behavior Matters – A Way Forward
Adversity and divisiveness related to world events exist. How we respond as healthcare practitioners and leaders matters. To preserve humanism in medicine, medical professionals and leaders, as Thibault has highlighted, “must call out … [harmful] behaviors when we see them—in our leaders, in our social interactions, and in our profession.” Critically reflecting on the behaviors within the healthcare environments outlined here post-October 7, 2023 demonstrates the necessity of preserving our moral values to deliver care without prejudice, empathize with our patients and colleagues, and foster effective teamwork and scientific advancement. Patients must be able to trust their healthcare practitioners and the environment of care.
Being grounded in humanism fosters our empathy and heartache for all innocent civilians in this difficult conflict and a hope for its end. The themes of patient dignity, empathy, mutual understanding, cooperation, and respectful discourse align with the recently proposed 4E’s action framework of Education, Engagement, Empathy, and Enforcement to foster moral responsibility, combat antisemitism and hate of all kinds, and promote an inclusive environment for “humanistic, non-biased care.” The “4 E’s” serve as an important approach for sustaining humanistic learning and practice environments. Our collective responsibility will ensure our capacity to deliver safe, ethically sound patient care for everyone while promoting scientific advancement through collaborative research and education.
Seth M. Cohen, MD, MPH is tenured Professor of Head and Neck Surgery & Communication Sciences at Duke University School of Medicine.
Hedy S. Wald, PhD is Clinical Professor of Family Medicine, Department of Family Medicine, Alpert Medical School of Brown University and faculty at Harvard Medical School Pediatrics Leadership Program.