Temperance

Definitions

1. Temperance is the virtue that moderates our attraction to pleasures and provides balance in the use of created goods
2. Self-control and moderation in all things
3. The virtue by which we govern our desires and use material goods appropriately

What is Temperance?

Temperance is the virtue of self-control and moderation. In medicine, it enables us to maintain appropriate boundaries, balance work and rest, and resist the temptations toward excess that can harm our practice and well-being.

Why should we practice the virtue of Temperance?

• Sustainable practice: Temperance prevents burnout by promoting healthy limits
• Professional boundaries: Appropriate limits in doctor-patient relationships
• Work-life balance: Moderation in work demands allows for rest and renewal
• Sound judgment: Self-control enables clear thinking and good decisions

How do we foster Temperance?

1. Set boundaries: Establish limits on work hours and availability
2. Practice saying no: Decline commitments that would lead to overextension
3. Cultivate rest: Prioritize sleep, recreation, and time with loved ones
4. Monitor yourself: Notice signs of excess or deficiency in various areas
5. Seek balance: Strive for the mean between extremes

Clinical Case

You are a busy surgical resident. It happens to be that you have a few minutes off in between operating room cases. You run down to the cafeteria to buy a quick slice of pizza and sit down to eat. You pull out your phone to see if anyone else has texted you - your medical students, attendings, OR techs and nurses. You respond as you eat your lunch. You finish replying to all necessary messages, and so you move onto checking your inbox. You click through various messages, reply quickly to those that could be replied quickly to. You then are about to put down your phone, when your thumb wanders to Facebook, and you spend the next five minutes finishing your slice of pizza while scrolling through various Facebook posts.

You look at your watch - the next case is about to start in a few minutes. You run into the elevator, and as you wait, you pull out your phone again. No messages, but you decide to check the news as the elevator makes a few stops to your final destination.

You scrub, gown up, and start the case with your attending. He’s known to be especially rude to everyone around him, so you prepare yourself for the worst. At one point, the patient’s heart rate starts to drop as both of you are trying to find the last bit of tissue still connected to the inferior vena cava in extracting a tumor. The surgeon goes in to snip the last bit of connective tissue adhering to the blood vessel.

Unfortunately, this results in an oozing of the inferior vena cava and the patient’s blood pressure starts to drop. The massive transfusion protocol is initiated, as it feels like everyone around the OR is moving in orchestrated, coordinated chaos. You hear your attending angrily yelling at the various nurses and/or OR techs. Though the patient ends up being able to be resuscitated, he ends up in the ICU for the next 2 weeks, on a ventilator, and not waking up.

You are rounding on the patient two weeks later with the ICU team. At this point, the patient has not woken up and has not had any cranial nerve responses. You hear the ICU attending say, “well, this family wants everything done. We can talk to them about a tracheostomy.”