Definitions
- Recognition of one’s own worth and limitations without seeking excessive honor or recognition, while also acknowledging and respecting the dignity and worth of others
What is Humility?
- “Humility” derives from the Latin “humilitas” coming from “humus” meaning “earth”
- Humility is NOT subservience but instead is characterized by MODESTY and SINCERITY
- Humility necessarily precedes the courage involved in sincere self-examination and allows us to begin to realize our mistakes or how we could improve.
- Humility is closely connected with fortitude, gratitude, and patience.
Why should we practice the virtue of Humility?
- Humility helps us deepen our relationships and progress in our personal growth.
- Humility involves being sincere in recognizing our talents so we can better use them in service of others. Overt self-pity is really a manifestation of pride.
- Humility makes us approachable, people are more willing to open their hearts to us than if we are sealed off and seemingly perfect.
- Pursuit of excellence often requires humility as it involves recognizing that there is always more to learn and room for improvement. By approaching work with a humble mindset, one can embrace the process of growth and development.
Aristotle’s Doctrine of the Mean
Aristotle’s Doctrine of the Mean emphasizes balance as the essence of virtue, symbolized here by a mountain peak with a flag representing the ideal midpoint. Each virtue lies between two opposing vices—deficiency depicted on the left, and excess, on the right slope. For example, courage is the balance between cowardice (deficiency) and recklessness (excess). In a medical context, this principle guides healthcare professionals to strive for the peak of ethical behavior, avoiding the pitfalls of extremes to ensure thoughtful and compassionate care.
Case Studies
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.”
Discussion Questions
- What are your initial reflections about this case?
- Are there similar experiences you have had in the past? What are some examples?
- What do you think about Dr. Smith’s handling of the various scenarios in the case? Would you have reacted differently? Was Dr. Smith’s response justified in certain circumstances?
- Why is the virtue of humility important in medical training? As a future attending?
- How can we grow deeper in the virtue fo humility during medical training and as attendings physicians?
How do we foster Humility?
- Embrace Constructive Criticism
- Engage in Self-Reflection
- Practice Active Listening
- Admit Mistakes and Apologize
- Serve Others
- Growing in thankfulness