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Shifting away from "one size fits all" medicine

The Aliki Initiative at Johns Hopkins Bayview celebrates its 10th anniversary
Posted November 17, 2017
  • "The Aliki philosophy is now a permanent part of our DNA here at Johns Hopkins Bayview," says David Hellmann, director of the Center for Innovative Medicine. "Patients love it. Families love it. Doctors and doctors-to-be love it, too, because it places an emphasis on connecting with the patient as a person." (photo by Chris Hartlove)

  • The founding gift by Aliki Perroti enabled (l-r) Laura Hanyok, Colleen Christmas, Cindy Rand, and Roy Ziegelstein to begin creating the unique curriculum residents experience as part of the initiative. (photo by Chris Meyer)

In 2007, Greek philanthropist Aliki Perroti made a major gift to establish the Aliki Initiative at Johns Hopkins Bayview Medical Center, a program designed to train general internal medicine residents to become expert physicians who are adept in the art of patient care. Now entering its second decade, the Aliki Initiative, part of Hopkins' Center for Innovative Medicine (CIM), has produced more than 170 physicians who practice in 25 states, Washington, D.C., and three countries.

"The Aliki philosophy is now a permanent part of our DNA here at Johns Hopkins Bayview," says David Hellmann, chairman of the Johns Hopkins Bayview Medical Center Department of Medicine and director of the CIM. Hellmann is also the inaugural Aliki Perroti Professor of Medicine, a chair endowed by a generous gift from Perroti in 2006. "Patients love it. Families love it. Doctors and doctors-to-be love it, too, because it places an emphasis on connecting with the patient as a person."

"There's been a very strong, and appropriate, emphasis on data, science, genetics, et cetera, in medicine in the past 50 years, but you need to be able to apply that science to an individual," says Aliki faculty member Roy Ziegelstein, the Sarah Miller Coulson and Frank L. Coulson Professor of Medicine and vice dean for education in the School of Medicine. "To do that, you need to know about a person's family, culture, social support, values, goals, interests — everything. And that's what Aliki practitioners are trained to do."

"You can do a lot of harm by missing something about a person's life, or you can arrive at the right conclusion for treatment faster because you understand what their life looked like before they came in. It's worth that up-front investment."
Jason Liebowitz, Hopkins rheumatology fellow

What makes Aliki different?

Following Perroti's gift, a core team led by Ziegelstein developed the curriculum for Bayview residents on the Aliki general internal medicine rotation — one of four services available to residents. The residents join Aliki attending physicians on rounds that differ from the traditional kind; rather than meeting outside the patient's room to discuss a "case," the Aliki team convenes inside it, involving the patient in the conversation about his or her care. In initial consultations, Aliki residents ask a variety of questions about the patient's life, including family, occupation, living situation, and hobbies — anything that may help narrow down a diagnosis and develop an appropriate treatment plan for that individual. Aliki teams often visit a patient's home after discharge, which can provide additional information about the patient's lifestyle that can influence a path of treatment.

Aliki faculty continuously assess the program through surveys of patients (in the past decade, patients have, on average, rated Aliki physician teams higher than others). They also examine its impact on medical residents, who consistently rate the Aliki experience as one of the highlights of their training and indicate the value of the program persists well beyond their training. Finally, the faculty engage in academic research; a recent study comparing outcomes for heart failure patients at Bayview showed that Aliki patients' readmission rates were lower than patients seen by other services — one of several findings that have been published by the Aliki core team.

"You become a more effective doctor"

Aliki alumni consider their training to be a burnout-prevention resource. Now practicing with Johns Hopkins Community Physicians, Sujay Pathak, MD (Med '11)  routinely sees 20 or more patients per day, a workload that at first left him feeling more like a technician than a care provider. He began emphasizing Aliki principles, such as the extensive social documentation, in his practice, with positive results.

"If you take time and be intentional about understanding your patient and his or her life, those 20-plus conversations each take a different flavor, your day becomes more fun, and you become a more effective doctor," he says.

Jason Liebowitz, now a Hopkins rheumatology fellow, acknowledges the Aliki approach does require an up-front time investment. But what's spent at the onset of a patient-provider relationship can prevent costly delays, in time and money, down the road, he says. Knowing a patient's interests or socioeconomic background can prevent a doctor from prescribing a prohibitively expensive medication or one that would interfere with the patient's daily activities. Knowing that a patient has limited access to transportation may prompt a doctor to connect the patient with transit services or prescribe a home-based therapy regimen.

"You can do a lot of harm by missing something about a person's life, or you can arrive at the right conclusion for treatment faster because you understand what their life looked like before they came in," Liebowitz says. "It's worth that up-front investment."

Expanding Aliki’s horizons

Groups beyond Bayview's general internal medicine department agree. Parts of the Aliki Initiative have been adapted and introduced at Bayview's Intensive Care Unit, the Hopkins schools of Medicine and Nursing, and at Hopkins All Children's Hospital in St. Petersburg, Fla. Academic medical centers at Brown University and the University of Virginia have also adopted aspects of the Aliki Initiative.

Ziegelstein hopes to expand this outreach in the Initiative's next decade, and Bayview Aliki alumni will be integral to that effort. Few of them have met Perroti, but even those who haven't had the chance feel a strong sense of gratitude to a woman who helped reinforce their passion for medicine.

"I've worked in big medical centers before where the prevailing thought is that the Aliki approach is nice, but it's not really possible in the real world," Pathak says. "Because of her gift, I know that's wrong – you can provide high quality care for the patient and care that's personally satisfying to the physician, and that has been life-changing for me."

To learn more about the Aliki Initiative or to make a gift to the Center for Innovative Medicine at Johns Hopkins, please contact Ashlyn Sowell, senior director of development.