History & Founders
“The best teaching is that taught by the patient himself.”
Sir William Osler, MD
In 2001 Dr. Bernard M. Bandman,a clinical psychologist, Celia Engel Bandman, a published writer, and the late Patricia A. Barr (1950-2003), a patient, lawyer, national healthcare advocate and policy expert, founded the Institute of Medical Humanism (IMH) as a 501(c)3 not-for-profit organization in Bennington, Vermont. The Institute was founded in response to their shared observation that patients and medical professionals spoke about illness in profoundly different ways–with entirely different vocabularies and, of course, informed by different experiences and views toward illness itself.
This observation shaped a commitment to create programs that would help bridge the gap between the patient’s perspective and the medical provider’s approach to care by focusing on their shared responsibility to communicate clearly and openly.
In 2002 IMH implemented its pioneering Medical Humanist Communication Model™ at a regional cancer center in Vermont. The objective was to incorporate a new professional entity, a “medical humanist,” into an interdisciplinary healthcare team. That individual’s role was to help facilitate doctor-patient communication and, to a larger extent, to act as a catalyst for the delivery of humanistic medical services in the healthcare system. The pilot program (2002-2005) revealed that patients, families, friends and medical professionals were all affected by illness in very different ways. Communication between all those within the “sphere of illness” is complicated–and deserves attention to ensure that there is a shared understanding about health condition, treatment choices and quality of life issues. The medical humanist’s documentation of patients’ understanding of their diagnosis, prognosis, treatment plan, and effects of illness on themselves and family proved to be a useful tool to address misunderstandings and improve satisfaction for patients and clinicians.
In 2006, the Institute launched its Center for Communication in Medicine (CCM). Building on the success of the pilot program and earlier fieldwork in medical and community settings, the Institute’s founders and Board of Directors recognized the importance of developing new programs to facilitate communication with the intent of sharing the materials beyond its region. Innovative “Conversation Hour” programs, offered to clinicians in the medical center, taught CCM about the challenges and dilemmas that doctors and nurses face in day-to-day practice. (Listen here to doctors discussing the Conversation Hour on Vermont Public Radio.) CCM also expanded outreach to the public through Community Education programs, which served as interactive public awareness forums to heighten awareness and offer guidance about navigating the lived world of illness. These programs emphasized the patient’s responsibility in initiating communication about their needs, concerns and goals for care. During this time CCM co-produced an award-winning segment for National Public Radio’s “The Health Show” in which patients with advanced cancer talked about their experiences.
It was with CCM’s medical and community education programs that the tagline, “Good Communication Is Good Medicine,” was born.
In addition to working with healthcare professionals and the public, CCM’s founders have established relationships with faculty at leading academic medical institutions. This has provided an opportunity to grasp the challenging task of teaching communication skills in the increasingly technology-driven field of medicine. The discussions with medical educators vastly expanded CCM’s knowledge base as it undertook the creation of new educational programs and instructional tools to improve communication between healthcare providers and patients.
CCM’s goals are: to further the understanding of the patient’s perspective; to recognize the needs and concerns of family and friends; and to acknowledge the difficult task that healthcare professionals face in reconciling patients to living with chronic and life threatening illness. CCM’s literature, videos, workbooks and educational programs emphasize the need for improved communication that depends not only on the doctor’s skill but also on the patient’s willingness to take responsibility for understanding his or her health condition and treatment choices, and to share in decisions about care.
CCM has well-established relationships with healthcare professionals, medical institutions, advocacy groups and policy makers. CCM has made presentations at medical grand rounds, conferences and community forums throughout the United States and in England. Committed to evidence-based research, CCM is collaborating on studies with the White River Junction VA Medical Center (VT) and Dana Farber Cancer Institute (Boston, MA). Journal articles by CCM founders and colleagues have appeared in the Journal of the American Medical Association, Journal of Cancer Education and the Journal of Clinical Oncology. Stories about CCM’s work have been featured on NPR, Vermont Public Radio and in newspapers nationwide. The organization’s mission has been supported through grants from the Centers for Disease Control, Kenneth B. Schwartz Center, Lenny Zakim Fund, Vermont Community Foundation, Arnold P. Gold Foundation and individual donors.
Dr. Bernard M. Bandman
A clinical psychologist who has been caring for patients and families at a regional cancer center in Vermont since 1988, Dr. Bandman understands the impact that a diagnosis with a chronic or life-threatening illness can have on both a patient’s sense of self and on his or her relationships. Uncertainty about the future creates fear and anxiety for patients and families. While these emotions are entirely normal reactions to a life-altering diagnosis, psychological stress can also affect the processing of information in the medical encounter–compromising a patient’s understanding of his or her prognosis, treatment options and other critical areas where decisions need to be made.
Healthcare professionals must also address their own psychological and emotional reactions to caring for seriously ill and dying patients. During his many years working in a medical setting, Dr. Bandman has provided education and training programs for physicians and nurses. In this capacity, he has observed how often physicians and nurses, originally drawn to their vocation because of their empathy and desire to heal, struggle with the duty of having to repeatedly deliver “bad news” to patients and their families. Working closely with medical professionals has convinced Dr. Bandman that it is critically important for them to understand the impact of stress on their work and on themselves personally, and recognize the influence of this stress on communication with their patients.
In 2001, Dr. Bandman co-founded the Institute of Medical Humanism, a Bennington, VT based non-profit, to produce programs to facilitate communication between patients, families and healthcare professionals. He serves as its Executive Director. In 2006, he helped the Institute launch the Center for Communication in Medicine (CCM), and he has since worked on the development of CCM’s numerous educational programs and tools. Dr. Bandman represents CCM on the Alliance for Quality Psychosocial Cancer Care, a national collaboration of healthcare professionals and advocacy groups working to promote psychosocial distress screening and treatment for cancer patients. In addition to publications in medical journals, he has been featured on NPR and Vermont Public Radio and appears in Dana Farber Cancer Institute’s “Living Beyond Cancer” video library. Dr. Bandman has presented CCM’s work at medical grand rounds, conferences and community education programs. Most recently, he produced the video for the Difficult Conversations Workbook.
Celia Engel Bandman
In 1998, Ms. Bandman, a published writer who made sense of the world through stories, found herself unexpectedly invited to serve in the role of patient advocate at a regional cancer center in Vermont. Listening to patients recount what they understood about their illness and then reading the words doctors used to describe those patients’ diseases, Ms. Bandman was struck by the language differences and resulting communication gap at the very center of the medical encounter.
Observing this, she began to wonder: Was there a role for a writer in healthcare? A growing movement in medical education sought to incorporate the humanities into the curriculum with particular attention to the link between storytelling, literature and the practice of medicine. However, the field of “medical humanities” had yet to be translated into a healthcare delivery model. To that end, Ms. Bandman envisioned a role for a “medical humanist”–someone who would document the patient’s story of illness-in his or her own words–for the doctor to review. This documentation would serve as a bridge between the patient’s perspective and the doctor’s understanding, opening the door to communication and, ultimately, to a decision-making partnership.
In 2002, Ms. Bandman had the opportunity to pioneer the role she had envisioned as the resident “medical humanist” at a regional cancer center in Vermont. She acted as a member of an interdisciplinary team helping to facilitate doctor-patient communication by documenting the patient’s voice alongside the clinical data in the medical record. The pilot program (2002-2005) proved successful in improving patients’ understanding of their diagnosis, prognosis and plan of care, resulting in greater levels of satisfaction with their doctors and nurses.
Ms. Bandman has had articles published in the Journal of the American Medical Association, Journal of Cancer Education, and Journal of Clinical Oncology. She created “Writing is Good Medicine,” a writing program that prescribes the pen as a tool to facilitate doctor-patient communication. Ms. Bandman serves on the Advisory Panel of Cancer.net, which provides comprehensive information from the American Society of Clinical Oncology to help patients and families make informed healthcare decisions. She lectures throughout the United States about her innovative approach to improving communication in healthcare delivery. She is a founder of the Institute of Medical Humanism and has been instrumental in launching new programs through the Institute’s Center for Communication in Medicine. Most recently, she created the Difficult Conversations Workbook and produced its accompanying video.
In 1991 the late Patricia Barr (1950-2003), a lawyer, brought her personal experience with breast cancer to the public arena. As a Board member of the National Breast Cancer Coalition, she helped focus attention on breast cancer in the areas of public policy, science, industry and advocacy. She believed in and fought for access to quality care, innovative research and synergistic new partnerships.
Ms. Barr visited Senator Patrick Leahy’s Washington office in 1992 with a small contingent of Vermont women who had survived breast cancer. This visit led Leahy–later joined by others in Congress–to urge the Secretary of Health and Human Services to declare breast cancer a public health emergency. Leahy and Barr worked together to convince Congress that millions of dollars should be dedicated in the Defense Department’s medical research budget to combat breast cancer. Since then, their efforts have funded nearly $1.5 billion in breast cancer research. “Nothing like this [had] ever been done before,” Leahy recalled. In 1998 Ms. Barr once again became an active patient. “There will never be a time,” she said, “that I will not be a patient.” By then, facing advanced disease, she focused on the needs of the population she represented. She opened her journals, serving as a reporter and exposing her fear and vulnerability.
Ms. Barr recognized that the patient-doctor relationship had its own set of stresses that were exacerbated in the care of the chronically ill. Such cases often brought higher expectations and more emotional investment on the part of both patients and doctors. Additionally, these patients often suffered from other health problems, meaning more doctors and more interactions that could lead to misunderstandings. Layers of uncertainty–one of the most difficult dilemmas in the care of the chronically ill–clouded every interaction. Ms. Barr believed the doctor and the patient “must develop a partnership. It’s a shared sense of not knowing–but a willingness to do the best we can.”
In 2001, Ms. Barr co-founded the Institute of Medical Humanism with the vision of developing programs to facilitate doctor-patient communication and build healthcare partnerships. She was instrumental in convincing the Southwestern Vermont Health Care’s CEO to support the Institute’s pioneering “medical humanist” model. We believe Ms. Barr would be pleased with all that CCM and IMH have accomplished with that pilot program and beyond. Our work is a tribute to her steadfast determination to improve quality of care through effective doctor-patient communication leading to a better understanding of the needs and goals of the person who is the patient.