Physicians Say Humanistic Care Survives Through Relationships, Not Formal Curricula

Medical schools have invested heavily in teaching humanism, yet the physicians who actually practice it say its survival depends far less on formal curricula than on relationships with patients, mentors, and role models. That is the central finding of a qualitative study published in the Journal of General Internal Medicine, in which researchers from Penn State College of Medicine explored how practicing physicians conceptualize, develop, and experience humanistic practice within contemporary healthcare environments.

The study, led by Rebecca L. Volpe and colleagues, used semi-structured virtual focus groups conducted in January and February 2023. Twenty-six practicing physicians from fifteen U.S. states took part, recruited through professional listservs, investigator networks, and snowball sampling. Participants included fourteen women and twelve men, drawn from primary care specialties, psychiatry, neurology, gastroenterology, geriatrics, and pediatric subspecialties. Their years in practice ranged from zero to fifty-three, with a mean of roughly eighteen years, spanning a broad spectrum of clinical experience.

Four focus groups of six to seven participants each lasted ninety minutes and were facilitated by an experienced qualitative researcher with no supervisory relationship to participants. Open-ended questions probed how clinicians understood humanistic practice and what facilitated or impeded it. The facilitator offered a working definition adapted from prior conceptual work to anchor discussion, and transcripts were analyzed sequentially using a thematic analysis framework. Three team members independently read all transcripts before collaborative line-by-line coding, with analytic memos documenting audit trails and reflexivity. The team defined saturation as no new themes emerging in a subsequent group, a criterion reached by the third transcript, so no additional groups were recruited.

Five interrelated themes emerged. First, clinicians described humanistic practice as fundamentally relational and inseparable from competent clinical care. Participants repeatedly merged the two ideas, treating them as one and the same: to practice competent medicine was to engage in humanistic practice. As one participant put it, when hearing the term humanistic practice, one might well ask what the other kind of practice would be. This theme was prominent across all four focus groups.

Second, participants found humanistic practice remarkably hard to define in abstract terms, even while readily recognizing it in action. When speaking abstractly, they relied on thin dispositional descriptors such as kind, nice, authentic, and self-aware. Yet when recounting actual clinical encounters, they produced richly contextualized narratives of complex relational work, careful attention to context, and nuanced judgment. The authors interpret this gap as evidence that humanistic practice may function as a form of tacit professional knowledge, deeply experiential and easily recognized but difficult to capture in language. Participants also emphasized that authentic connection could not simply be performed, noting that patients are highly attuned to whether physicians are genuinely present and engaged.

Third, human relationships emerged as the primary way clinicians learned and sustained humanistic practice. Patients, mentors, and role models were all identified as key teachers, with patients described as particularly powerful instructors. Notably, the same meaningful relationships also supported clinician resilience. Participants described their connections with patients as rejuvenating, a remedy to feeling burned out, and what renews them. Because these comments were often paired with remarks about burnout and the negative aspects of clinical work, the authors suggest that participants perceived humanistic practice as protection against the dehumanizing pulls of medicine.

The fourth and fifth themes described forces working against humanistic practice. Participants identified healthcare system priorities centered on efficiency, standardization, commercialization, and productivity as actively undermining it, pulling attention away from patients as people and toward checklists and metrics. Some used vivid combat metaphors, describing humanistic practice as an act of resistance and speaking of developing a protective layer of armor in response to the clinical environment. Medical training itself was also seen as damaging: participants said pedagogies emphasizing objective right and wrong answers, pattern recognition, and reductionist knowledge clashed with the messy realities of caring for whole patients, and that their education knocked down or smashed out native empathy. Humanistic practice was not consistently role modeled, with one participant noting they had to do it in secret, and another observing that first-year students arrive idealistic before the system stamps it out of them.

From these findings, the authors draw three implications for undergraduate medical education. Humanistic practice should be framed explicitly as a set of teachable skills rather than a constellation of personality traits, since describing it as simply being kind obscures its complexity and renders it unteachable. Educators should also integrate two parallel conversations: the structural realities of healthcare, including insurance systems, productivity metrics, and relative value units, and the humanistic values trainees are asked to embody. Learners who can describe how RVUs are calculated but not how productivity pressures affect their ability to be present with a patient are only partially prepared, and those who enter clinical environments without that integrative framework risk experiencing the gap between their values and reality as personal failure rather than systemic dysfunction. Finally, the authors highlight that humanistic practice sustains physicians themselves, framing it as a resource for meaning, resilience, and professional sustainability rather than merely an ethical obligation.

The study arrives as the AAMC has revised its core competencies for undergraduate medical education to reflect principles of humanistic practice more explicitly. The authors caution that realizing these competencies will require more than curricular statements, and that operationalizing humanistic practice through standardized checklists may inadvertently mirror the very industrial forces clinicians experience as dehumanizing. A more effective approach, they argue, is preparing learners to recognize and navigate systemic forces while cultivating institutional environments that protect relational time, value clinician judgment, and reward authentic engagement with patients.

The authors acknowledge important limitations. The virtual, group-based format enabled geographic diversity and informal member checking but was vulnerable to social desirability bias and limited observation of nonverbal interactions. The recruitment strategy emphasized clinicians with a preexisting investment in humanism, yielding rich discussion but not a representative sample of physician specialties, which may limit generalizability. Including a former focus group participant on the analytic team strengthened interpretive resonance but introduced the possibility of preferential amplification of perspectives, which the authors say they mitigated through consensus coding and reflexive discussion. Future work, they suggest, could incorporate representative purposive sampling, individual and in-person interviews, direct observation, and perspectives from patients and interprofessional clinicians.

Subject of Research: How practicing physicians develop, sustain, and experience humanistic medical practice within contemporary healthcare systems

Article Title: Relationships, Resilience, and Relative Value Units: A Qualitative Study of the Promotion and Erosion of Humanistic Practice

Article References: Volpe, R. L., Haidet, P., Thompson, B. M., & Dalke, K. B. (2026). Relationships, Resilience, and Relative Value Units: A Qualitative Study of the Promotion and Erosion of Humanistic Practice. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10719-6

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10719-6

Keywords: humanistic practice, qualitative research, focus groups, physician well-being, medical education, hidden curriculum, burnout, healthcare systems, physician-patient relationship, resilience, industrialization of medicine, Journal of General Internal Medicine