Amy Ship, M.D.
Beth Israel Deaconess Medical Center internist Amy Ship, M.D., understands that she won't see a patient walk into her office in 25 years and thank her for preventing a stroke. But what drives her is the realization that the power to prevent disease, while not as dramatic as a surgeon's ability to cure it, is beneficial to the patient. "We know that modifying risk factors for heart disease and identifying illness long before it is going to be catastrophic is lifesaving," says Ship. "We just don't have the 'I took out your appendix and saved your life' moment. If you are able to hold on to that much more subtle, amorphous joy, it is there."
At Healthcare Associates, BIDMC's hospital-based academic primary care practice, Ship has been providing preventive care for many of the same patients, their children, and sometimes their parents for 18 years. The long-term relationships allow her to understand illness in the context of an individual's life. She doesn't get the isolated snapshot of a surgeon. Instead, she is aware of how her patients deal with chronic illness and can provide care based on that k"nowledge. "Primary care may not have the sexy allure of other specialties, but it's actually a really powerful and exciting domain in which to work," she explains.
Primary care is at the forefront of health care reform. Under new models of reimbursement, hospitals will be rewarded for keeping patients healthy, something Ship and BIDMC's Division of General Medicine and Primary Care have been focused on for years. "Through research, we now know that in countries and communities with outstanding primary care, people are healthier. They live longer, they spend less money on their health care, they need fewer interventions, and they are doing better," she says. "I don't think primary care physicians here are really changing what they are doing as much as the rest of the world is finally waking up and realizing that what we do is valuable."
Ship hadn't planned to be a physician. After securing degrees in English literature and art history, she worked as a journalist and a museum curator for six years before she realized her heart was in medicine. "I left a career where I had an office at the Guggenheim overlooking Central Park. I wore nice clothes and high heels. I left it all to go to the Bronx and deal with blood, sweat, and bodily fluids," she recalls of her time in medical school at Albert Einstein College of Medicine. "I am glad I did. The real joy is now being able to bring both of those worlds together and to teach medical students and other clinicians about thinking in complex ways about the human experience."
Integrating a liberal arts education with the practice of medicine has been a tremendous advantage for Ship-and for her patients. Today, much to her enjoyment, approximately 50 percent of her time is spent teaching on a variety of topics. She offers workshops that use literature and the arts to enhance empathy among her students and colleagues. "Although most would agree that communication and compassion are crucial to being a good physician, the work to teach these skills is often not valued in the way that work teaching medical content is," says Ship. "It would be extraordinary to devote money to improving communication skills for clinicians." While she acknowledges that finding funding for work in humanism is a challenge due to the lack of hard evidence, she argues that support focused on this critical aspect of medicine can have a tremendous impact. "Listening well is probably the most powerful component of care. And we don't teach that routinely," Ship explains. "When you communicate well, you are more efficient. You order fewer unnecessary tests when you have the time to listen to patients, and patients feel better cared for."
The challenging, yet satisfying, role of a medical educator has played a larger part in shaping who Ship is today as a primary care physician and has helped her to become a highly reflective and thoughtful practitioner. She has been recognized with awards for her work in mentoring, humanism, and teaching, including the 2010 S. Robert Stone Award for Excellence in Teaching, BIDMC's highest education award. In 2009, she was honored with the Schwartz Center Compassionate Caregiver Award-a prestigious prize that recognizes the caregiver in Massachusetts who best personifies the mission of the Schwartz Center to advance compassionate health care. "I am very proud of the award, but there are some amazing clinicians, especially in this division, who go unnoticed," she says of the honor, which took her completely by surprise. "I have a lot of colleagues here who don't get acknowledged for the moment-to-moment care of people that is really award-winning."
Ship and her colleagues at Healthcare Associates are ahead of the curve when it comes to new approaches to keeping patients healthy. "There is a lot of research, energy, and thought that goes into how we are practicing and what we should be doing," she says. "That is one of the joys of working at an academic practice." She notes that they treat patients based on what they know about populations and also the specific individual, applying interventions like managing blood pressure and doing pap smears that can ultimately be lifesaving. During a typical patient visit, Ship also focuses on identifying and discussing behaviors that can be destructive to overall health. There is evidence that if a doctor talks to a patient about smoking cessation for five minutes, the incidence of quitting goes up. "We have that capacity," she says. "It takes time, which is our most precious resource right now. But it is a painless intervention, and it makes a huge difference."
This focus translated into an editorial published in the New England Journal of Medicine in 2010 urging doctors to counsel their patients about the risks of distracted driving. The message in her article was simple: driving while distracted, whether it is talking on the phone or texting, increases the likelihood of accident and injury, and in some cases death. "As I say to my patients, there is no phone call that is worth putting your or anybody else's life at risk," she says. Since the article was published, Ship has discussed the potential dangers with all of her patients and encouraged them to change their behavior. She notes that when she has followed up on the request, the majority of her patients have stopped using their phones while driving. "Primary care doctors are uniquely positioned to teach and influence patients; we should not squander that power," she concludes in the article. "A question about driving and distraction is as central to the preventive care we provide as the other questions we ask. Not to ask-and not to educate our patients and reduce their risk-is to place in harm's way those we hope to heal."
Over the course of her BIDMC career, Ship has been exploring the possibilities in primary care in order to treat all of her patients with the compassion and expertise they deserve. "I like the diversity of my job," she explains. "I have an extraordinary community of colleagues. I love being in academic medicine; I am constantly challenged and constantly learning. I see patients, I teach, I write, I edit. No day is quite like any other, and I love that."