These days, we are being pulled in many different directions. So many demands are made on the little time that we have. We are always in a rush, and it is so easy to spark a flurry of irritability in any of us. We are all human, and getting irritated happens to even the most saintly and mild-mannered of us. No one is immune from the vagaries of human emotion in reaction to stressors. As physicians, we are held to a higher standard of being able to keep our emotions in check despite all that is thrown at us. On that note, I am sending you this article that I wrote for the Grossmont Hospital Physician in 2010 and would like to gently remind you (and myself) to be unflappable.
Aequanimitas
"Thou must be like a promontory of the sea, against which, though the waves beat continually, yet it both itself stands, and about it are those swelling waves stilled and quieted." Marcus Aurelius
On my first day of medical school at the University of Toronto, back in the Dark Ages, a professor handed out copies of a Sir William Osler (SWO) book, containing the essay "Aequanimitas". I recently re-read the essay, 22 years later, and it is profound. In my new job as Chief of Staff, I have had the responsibility of addressing behavioural QVRs (quality variance reports) on physicians. Some of you have had phone calls or meetings with the Chief(s) regarding these issues. In general, most of these QVRs involve good physicians, kind and caring people, who in an unfortunate moment, lose control or have a lapse in judgment. Some involve a misunderstanding or misinterpretation of tone, body language, or spoken words.
In his essay, SWO eloquently stated, "In the first place, in the physician or surgeon no quality takes rank with imperturbability". He went on to say, "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." He opined, "Even under the most serious circumstances, the physician or surgeon who allows his outward action to demonstrate the native act and figure of his heart in complement extern, who shows in his face the slightest alteration, expressive of anxiety or fear, has not his medullary centres under the highest control, and is liable to disaster at any moment."
Not bad for a fellow Canadian, eh!
Here's my 2010 summary:
Be unflappable. Remain calm. When righteous indignation rises in your belly at being called by a nurse or a volatile situation about to erupt, remember that you are the doctor. You are the leader to whom others are looking to provide strength, decisiveness, knowledge, and reassurance. If a medical error is being committed, speak up calmly and rationally. I would hope that our nursing staff will engage in a constructive dialogue with us at the grassroots level, on a case by case basis, in real-time, as we all have the same goal of providing super-awesome care to our patients.
If you do start flapping, unless you can grow wings and take flight to extricate yourself, then do what we learned in kindergarten - say "I'm sorry". You will probably find that our nursing friends will be very forgiving. They know that we are as human as they are.
Remember - Aequanimitas!
