Towards Aequanimitas: Why we still need Osler’s principles in 2015

On May 1, 1889, Sir William Osler delivered the Valedictory Address at the University of Pennsylvania, and spoke the watchword, which has become a landmark for medical students world wide: Aequanimitas. Literally, the word means equanimity or imperturbability, and Sir Osler states in the speech that, “in the physician or surgeon no quality takes rank with imperturbability”.

So what is this quality that he so preached? In his own words:

Imperturbability means coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril, immobility, impassiveness, or, to use an old and expressive word, phlegm. It is the quality which is most appreciated by the laity though often misunderstood by them; and the physician who has the misfortune to be without it, who betrays indecision and worry, and who shows that he is flustered and flurried in ordinary emergencies, loses rapidly the confidence of his patients.

In today’s world, where every single day we find stories of vitriol directed at Physicians dominating the social media, I think this speech of Osler’s becomes more important. Today, more than ever, are we in need of aequanimitas.

With more and more professional bodies admitting that an overwhelming majority of physicians face violence from patients and patient families, even in cases where there is little to do as doctors, this quality becomes more important. Reacting tactfully in potentially dangerous situations requires calmness, equanimity and an ability to communicate, that we are, unfortunately, not taught in medical schools.

It has become the fashion to make scapegoats out of physicians nowadays, and the sins of the few have besmirched the entire profession. Unfair as it may sound, even the most conscientious of physicians have their intentions doubted by the media, the patients, the patients’ families, simply because the general impression that has been cast has been so negative! Few stories of heroism of physicians emerge in the general media, while the tales of the few charlatans travel at the speed of light.

Nobody speaks of the surgeon and the anesthesia team which labored on through a rampaging earthquake without flinching for a second because that would jeopardize the patient’s life; however, everyone speaks of movie-star hosted, TV show based allegations against a select few physicians with a generalizability that hurts the entire profession. Facing such undue criticism, not being affected by them, and continuing to do one’s job with diligence requires a measure of equanimity as Osler spoke of.

Medicine today, as much as we would hate admitting to it, has become a dog-eat-dog world. In the mad rush to become super-specialized practitioners, we have ended up undermining the basic medical degree. In the pursuit of a coveted degree in a specialty, we have ended up defeating the very principles of developing a three-tiered medical system. Everyone wants to be a specialist, nobody wants to be a family physician or a medical generalist! And this immense pressure has come with its own retinue of gruesome consequences. Physician burn out, once an unthinkable affair, is routinely happening. Stories of bright medical students or doctors committing suicide because they could not enter into the hallowed pantheons of a desirable specialty has become commonplace. It has become an annual occurrence after the declaration of results, to find heartbreaking stories of physicians who chose to end their lives because they could not find their way into a desirable specialty.

With such social, market, economic and academic pressures to perform, it becomes essential to be able to develop the even-mindedness that Osler spoke of in his address. Aequanimitas makes us take failures with the same mental placidity as it does with success. When the outcomes of failures are so devastating, we cannot deny the need to build up the quality Osler rated so highly.

In the 125-odd years that have passed since Osler spoke in Pennsylvania, medicine has grown in leaps in bounds. Medical education has broadened and today diagnostics and therapeutics have grown to such proportions, which would have been inconceivable in those days. However, little has changed as far as the need for physicians to develop that quality which Osler spoke of so long ago is concerned. If anything, in 2015, doctors are more in need of developing aequanimitas than they were ever in need of in 1889.

Further Readings:

1. Aequanimitas, the address, from the Johns Hopkins archives: http://www.medicalarchives.jhmi.edu/osler/aequessay.htm
2. Oslerisms or Quotes of Osler: Life in the fast lane blog (Australia): http://lifeinthefastlane.com/resources/oslerisms/

Pranab Chatterjee, MD, is a skeptic Oslerphile, a medical doctor with a concentration in Community Medicine and Public Health who blogs (sporadically) at Scepticemia (http://www.scepticemia.com).

His blog has won several blogging awards, notably, the Runner up for the best new blog in the 2010 Medgadget Blogging Awards and the Best Medical Blog in India at the Indiblogger Blog Awards, 2013.

He is a prolific tweeter (@scepticemia: http://www.twitter.com/scepticemia) and an open access advocate.