Pulling Back the Curtain: Fred Schiffman, MD

Sigal Family Professor of Humanistic Medicine, vice chairman of medicine, and associate physician-in-chief of The Miriam Hospital, as well as associate program director of Categorical and Preliminary Programs in Medicine at the Warren Alpert Medical School of Brown University, and Medical Director of the Lifespan Comprehensive Cancer Center in Providence, Rhode Island

What was your first job?

One of my early jobs was as a waiter at Camp Laurelwood, a summer camp where my parents worked. I waited on four or five tables of screaming kids who routinely spilled things, and on hungry counselors who wanted their food immediately. When I was toiling as a server, I had to simultaneously monitor the fracas in the kitchens. The people who worked in the kitchens were constantly fighting, throwing pots and pans, and tossing ladles of boiling hot soup at each other. Multitasking, avoiding danger, and being a referee for fights were all in a day’s work – it was probably the best preparation I had for being an intern, resident, and chief resident. These skills were polished during medical school at Bellevue Hospital and as a house officer at Yale.

I also worked at a carwash, where my primary responsibility was to jump in cars as they rolled out of the carwash in neutral and put the brakes on to stop them from rolling into the street. I should mention that I didn’t know how to drive at that point. The people I worked with knew this and would torture me. They’d physically restrain me until the car was about two feet away from the street, when I’d have to race to get into the car. That’s how I learned aequanimitas, though. The guys wanted me to get excited and crazy, and I just wouldn’t do it.

The Schiffman clan at a recent family gathering
The Schiffman clan at a recent family gathering

Tell us about your family. Who were your role models growing up?

My mother was an immigrant from Poland and my father was a child of immigrants. They met at the Educational Alliance, a Jewish resettlement house, in New York’s Lower East Side. My father’s family owned a shoe store in Brooklyn, and as with most immigrant families, the way to success in America was through education.

My father earned a bachelor’s degree in education from New York University, then a master’s degree in science, and then degrees in advising and guidance counseling. For most of his life he was a coach and a teacher, but he and my mother (a nursery school teacher) also worked at a number of summer camps as counselors, leaders, and occasional entertainers. My brother and I were practically brought up in these summer camps. Being at the camps was more than just playing volleyball and soccer, though. We got to see our parents in action, guiding and shaping people’s lives at an early age and helping develop the careers of the college-aged counselors.

My father first taught at Jefferson High School in Brooklyn, where he had been a student. He was then transferred to McKee Vocational High School in Staten Island – which was considered “the country” back then – where he was a basketball and track coach and guidance counselor. During the school year, my brother and I went all over the city to watch his team’s track meets where, again, we saw him in action. Many of the kids on his team were from troubled homes and some had substance abuse problems, but he got the best out of them.

He had done the same for the wounded soldiers he helped as a rehabilitation officer in the U.S. Army. He took people who were physically broken and built them back up.

When my father passed away in 1997, we sat shiva and received condolence calls from so many people who said, “Your dad transformed me.” I have letters from some of the people he helped rehabilitate in my files; I read them and I say to myself, “I really am my father’s son.” My brother is too, for that matter. He is head of pulmonary/critical care at Mount Auburn Hospital in Cambridge and has won a whole series of awards for the teaching and care he has provided.

What was your childhood like?

My brother, Robert, who is 21 months younger than I, and I had an idyllic life. My parents were conscious about creating a non-competitive environment and valued us for who we were as individuals. We were, and still are, each other’s closest friend. Actually, Robert didn’t speak until he was almost three years old. My parents thought he had some kind of neurologic problem! When he finally spoke, they asked him why he hadn’t said anything, and he simply replied, “Freddie speaks for me!” I stopped a while ago, though.

As you would expect, there was a lot of kindness and nurturing in our household. If I’ve been a success, it’s because of my early coaches, mentors, and guides – my mom and dad.

If you hadn’t gone into medicine, what career could you see yourself in?

I would have happily been a teacher, probably in a high school. I did some theater in high school and there is an element of performance in teaching – or wizardry, really – that appeals to me. However, someone much smarter than I am said that there are many elements that make up a good teacher, but the one absolutely essential item is caring and ensuring that their learners “get it” – everything else is just technique.

Who have been some key role models and mentors in your career?

When I was at Yale, Samuel Thier, MD, was one of my most important teachers. He is a brilliant clinician who showed me the importance of kindness and blending art with science. Charles Carpenter, MD, at Brown University, is a majestic individual and a caregiver extraordinaire. He was always present with his patients, showing us how there is no substitute for actually being there. He was my teacher and also taught my son, Josh, when he was a medical student! It was great to see him in action at several levels. Robert Gifford, MD, Edwin Cadman, MD, and Tom Duffy, MD, at Yale were very influential. And, at Brown, Edward Wing, MD, and Louis Rice, MD, have been leaders and friends who have encouraged me to evolve and develop interest in humanistic medicine. All of these people are continuing inspirations for me.

As a mentor, what advice do you give to medical students or fellows early in their career?

As beautifully articulated by John Romano, MD, an insightful physician-leader, our mission as physicians and mentors is “to keep paramount one’s concern for the patient and the patient’s family, to prevent distress when possible, and to do what one can to return the patient to his or her role in society before illness occurred; by example, as well as by precept, to demonstrate to one’s students the therapeutic intent of medicine – the basic wish to comfort, relieve pain, and, when possible, prevent distress in those entrusted to one’s care.”

I tell young trainees to do what you love, but recognize that certain parts of the day aren’t going to be fulfilling. As you’re starting out, political and economic battles will always pop up, but try to avoid them and concentrate your efforts on your patients and their families. Establish your reputation as a superb caregiver first and everything else will fall into place.

As the saying goes, “Choose a job you love and you will never have to work a day in your life.” So, make your work your play. People who love what they do are truly blessed. It may take a little bit longer to get on the pathway to what fulfills you, but that’s okay. Don’t hurry to your destination – enjoy the journey. In academic medicine today, the old model of the “triple threat” is still sought after, but, to borrow a football analogy and the words of another author, most academic triple threats are really double fakes. If you try to be an expert in research, patient care, and teaching, you may end up being good at many of these things, but you probably won’t be a virtuoso in all three.

Also, have no regrets about a meandering path. Early in my career, I spent time in the lab at the National Cancer Institute, but I really felt drawn to the bedside. This wasn’t wasted time, though: What I learned from basic research continues to inform my patient and family interactions.

Self-care is essential in humanistic medicine, as well. So, when I mentor people, I try to emphasize the need to set personal goals and add balance back to your life. For me, mentoring involves working with the whole person, not just that person’s career pathway.

Lastly, put family first and try to organize your life and your days in a way that you can be a parent to your children and a good partner to your spouse. It’s not always the kids’ scheduled meetings and games where that happens, – it’s the small, amazing times when you’re shopping or discussing things at home that can be the most wonderful parenting events. Keep your eyes open for the moments of grace that suddenly appear at home and at the hospital.

How do you achieve that balance between work and family in your own life?

My wife, Gerri, has allowed it all to happen. I’m very fortunate. We met in the summer of 1969 and married a year later. She was the anchor for all our children until our youngest turned 12, and then she started an astonishing career in real estate. She also defines herself by her rowing. She’s a competitive rower; I call her a world champion, since she won a gold medal in Montreal in a coxed four in 2001.

Luckily, we lived very close to the hospital, so I never missed dinner with the kids. I read them their bedtime stories, and after they went to sleep, I could go back to the hospital and finish up some work.

We have four amazing children. Josh, who’s now 42, was born in the middle of my internship. When he was 15, he developed Hodgkin lymphoma. He and I drove to Boston several times a week for several months for his radiation treatment; those were poignant, heart-wrenching, and remarkable hours we shared. It wasn’t the most challenging thing that happened to a family, but it was difficult for ours. Josh went to college and then medical school at Brown, and trained in pediatrics and hematology/oncology at Stanford. During his training he started to take an interest in pediatric cancer and hereditary cancer syndromes. Josh is now an endowed professor in pediatric oncology at the University of Utah and the Huntsman Cancer Institute, researching why elephants don’t get cancer and hoping to prevent it in children. He and his wife Maureen have three wonderful children, Noah, Ben, and Lily.

Jessica, our daughter, took after my wife and rowed at the University of Pennsylvania. She and her husband David (who was one of our medical residents at Brown!) have two terrific children, Jackson and Sydney. David is a gastroenterologist and Jessica is using her MPH degree to help organize equine therapy for autistic children.

Our son Jake was always the foodie in the family, and now he’s a lead buyer for the Food Network. We think he should be in front of as well as behind the camera – his fiancée Lauren agrees.

Judd, our youngest, is the adventurous one. Right out of high school, he worked at an orphanage for children with HIV in Zimbabwe and then got his college degree in human development, and recently an MFA. He and his wife Athena are ceramicists and sculptors.

All our kids and now grandkids have done different and surprising things. They’re the center of our lives, but we try not to be meddlesome or annoying parents and grandparents. Most of the time I think we’re successful.

In a typical day, what is your rose and what is your thorn?

Working with colleagues’ goals and helping to make them a reality brings me the most pleasure. Assisting and watching students and trainees grow as they care for patients is a wonder to me. It is the essence of what I try to do. Even though I have several other jobs, I couldn’t do any of them without caring for patients, and teaching others at the same time.

For myself and the health-care system in general, I think there’s a large and sharp thorn we all have to deal with: the electronic medical record (EMR). In my opinion, it has impaired our ability to be with patients and families. With the way that the EMR works and how information is recorded, we have eliminated the detailed narrative of illness and the richness of prose.

The narrative has been replaced with checkboxes and “smart phrases.” The problem is, they’re not so smart.

EMRs have changed my workflow and not for the better. Can they serve as a basis for certain research projects? Can they improve quality and safety? Maybe, but for many people, the focus has shifted from the patient care arena to the documentation arena, and the EMR seems to be a distraction and diversion from the important practice of patient care. Humanism is under assault in the modern health-care system, and, despite efforts by clinicians throughout the country to “humanize” EMRs, we haven’t yet figured out how to successfully incorporate this record-keeping into our lives as caregivers.

How do you “protect” humanistic medicine?

The basic components of humanistic medicine are: integrity, excellence, compassion, altruism, respect, empathy, and resilience. Resilience is particularly important for caregivers and the patients that we see as hematologists/oncologists. Our patients’ days are going to be tough, and they have to be able to pick themselves back up the next day and the next day. To be resilient, patients have to have internal reserves to draw upon, as well as the external support from friends and family. Physicians must be similarly resilient to minister effectively to patients and their families at the bedside – not via email or phone. As Abraham Verghese, MD, said, “The importance of an attentive, thoughtful presence at the bedside by the physician cannot be overestimated. One might cure without seeing the patients, but to heal a patient requires presence.”

The team approach is also integral; our nurses, social workers, and navigators greatly enhance our patients’ quality of life.

My endowed chair in humanistic medicine has given me a platform and coordinating role across Brown University; we work together with the Rhode Island School of Design on a variety of teaching and learning activities. As the faculty advisor for the Gold Humanism Honor Society at Brown, I also help design, nurture, and enhance humanistic programs and projects throughout the medical centers.

In that same vein, I teach a humanistic physical diagnosis class to medical students that concentrates on how to bond with patients in a few minutes, not on the patients’ physical findings alone. Some people might ask why I teach an entry-level course like this, but it’s thrilling to see these medical students at an early stage of their development develop relationships with patients.

In hematology/oncology, we are dealing with people who are struggling. It’s essential that we teach younger colleagues how to be not just good doctors, but good caregivers. Illness is how disease affects your soul; we have to know how to deal with that, and not just with the altered physiology of disease. Clinical excellence, of course, is essential to being a humanistic caregiver. There is no battle between the art and science of medicine – both are needed.

If you look at what we need to heal and cure patients, the time we spend with them is critical. Put simply, it’s bad if we don’t sit and talk with patients and their families; it’s less satisfying for us as caregivers and it costs the hospital more because reimbursement is tied to how patients feel about their care. You have to understand people and spend time with them – not an easy task given the time pressures on our days.

What do you do in the off-hours – if you have any?

I play guitar often – it’s a great stress reliever. There are many guitar heroes and musicians I try to emulate: Bob Dylan, the Beatles, Paul Simon, Leonard Cohen, Leo Kottke, Jim Croce… I continue to write short stories, poetry, and songs, too. Some may be ready for publication soon.

I still paint and draw a bit – I was the medical illustrator for a surgical pathology manual when I was in medical school and I have done illustrations for a couple of hematology texts I have edited.

In the summers, we have our own sort of summer camp since we now live in the country. All the kids gather at our home, and we go to the beach and sail or kayak. When I come home in the summer evenings, and the sun’s still out, and the grandchildren all greet me, I’m reminded how blessed I am. Seeing the fun and harmony among my kids and grandkids is a genuine blessing. Of course, our kids fought like cats and dogs when they were younger, but now it’s wonderful to see them all getting along and enjoying each other. And now, of course, my children have become my teachers.

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