Humility

Definitions

1. Humility is the virtue of having an honest and modest view of one's own importance
2. Accurate self-knowledge without pride or false modesty
3. The virtue that moderates our desire for excellence by keeping us grounded in reality

What is Humility?

Humility in medicine means recognizing both our capabilities and our limitations. It enables us to seek help when needed, admit mistakes, continue learning, and treat others with respect regardless of their status.

Why should we practice the virtue of Humility?

• Patient safety: Humility helps us recognize when we need to consult others or admit uncertainty
• Continuous learning: Humble physicians remain open to new knowledge and correction
• Team collaboration: Humility enables us to learn from colleagues of all levels
• Error acknowledgment: Willingness to admit and learn from mistakes
• Patient respect: Humility helps us see patients as partners rather than passive recipients

How do we foster Humility?

1. Seek feedback: Regularly ask for input from colleagues, patients, and supervisors
2. Acknowledge limitations: Practice saying "I don't know" when appropriate
3. Learn from everyone: Recognize that knowledge and wisdom come from unexpected sources
4. Reflect on mistakes: Examine errors honestly without excessive self-criticism
5. Celebrate others: Genuinely appreciate colleagues' contributions and successes

Clinical Case

You are the senior internal medicine resident covering one of the general medicine inpatient teams. You have been on service for the past two weeks and know your patients very well. You are known among your co-residents as being very conscientious, thoughtful, compassionate, and detail-oriented in your care for patients.

Today is a Tuesday, which means that there is a new attending on service. This attending is a new hire and therefore, it is your first time working with her. The attending, Dr. Smith, two junior residents, and you start rounding on the inpatient service. You take the lead given you are the senior resident, and the juniors are presenting to you.

The third patient, Ms. JS, notes that her nausea has not been better despite scheduled ondansetron 8mg q8h. Outside of the room, the junior suggests trialing olanzapine 2.5mg q8h given Ms. JS is also struggling with some sleep and appetite issues due to her underlying cancer. You congratulate the junior for being thoughtful and agree with the plan. However, after agreeing with the plan, Dr. Smith jumps in and states that she feels that we should do 5mg/2.5/5mg. The next few patients you experience the same issue where Dr. Smith seems to suggest changes to your plan that feel more stylistic than evidence-based, and you feel like you’re losing your confidence in front of the junior residents.

Later that morning, you’re paged to Ms. JS’s bedside because her family is distressed. You run over and notice that Ms. JS just looks very somnolent. Looking at the medications she received, she had gotten the 5mg dose of olanzapine about 2 hours earlier. You feel like that dose was too high. Ms. JS’s husband is upset that she seems so sleepy. You sit down, explain the situation to him that you think her somnolence is medical-related, and you decide to hold the olanzapine. She slowly returns back to baseline over the next few hours.

The next morning, on rounds, Dr. Smith notes that the olanzapine wasn’t given. You explain that Ms. JS was somnolent, so you had made the decision to hold the olanzapine. Dr. Smith says in front of the team as well as Ms. JS and her husband, “Well, I wouldn’t have done that. I would’ve gone down to 2.5mg every 8 hours, in that case.”