The Latin word aequanimitas (refers to aequo animo, “with even mind” or “equanimity” or “impartiality”) is often used in medical circles to describe the ideal state of mind for a physician. It was first used by the Roman physician Galen to describe the ideal temperament for a doctor. The term has since been used by many other physicians, including William Osler, who famously said, “One of the first qualities of a physician must be that of aequanimitas…Without it, no real success in medicine can be achieved.”
Aequanimitas is seen as an essential quality for physicians because it allows them to maintain their composure in the face of sickness and death. In essence, a sort of calmness amid the storm. It also helps them to make clear-headed decisions in the midst of a crisis. In recent years, the concept of aequanimitas has been expanded to include empathy and compassion, as well as the ability to maintain a sense of humor in challenging situations. Ultimately, aequanimitas is about maintaining one’s humanity in the face of suffering and loss.
Introduction
Sir William Osler (1849-1919), one of the most influential figures in modern medicine, was a strong advocate of this concept. He believed that a doctor should be calm and level-headed in all situations, even in the face of adversity. This quality would allow them to make sound decisions and provide care that was in the best interests of their patients. While many modern physicians strive to achieve this ideal, it is not always easy. In a fast-paced and ever-changing field, it can be challenging to remain calm and collected at all times. However, those who are able to maintain aequanimitas in their work are often considered to be some of the best in their field.
Osler believed that a doctor must be able to maintain an even temper and calm demeanor in order to effectively treat his patients. He also believed that a doctor should never become too attached to any one patient, as this could lead to emotional distress and cloud his judgment.
While some may see Osler’s views as cold and impersonal, he was actually a very compassionate man who cared deeply for his patients. He once said, “The physician’s duty is not to stifle nature’s process, but to assist her.”
Osler’s aequanimitas has become one of the most iconic concepts in medicine. It is a reminder that, as healthcare providers, we must always remain calm and level-headed to provide the best possible care for our patients.
Selected excerpts from his great work “aequanimitas” which includes a collection of addresses to medical students will be discussed next.
The teacher and Student
“There are two aspects in which we may view the teacher – as a worker and instructor in science, and as practitioner and professor or the art; and these correspond to the natural division or the faculty into the medical school proper and the hospital”
The role of the teacher in medical education is to prepare future doctors for the challenges they will face in clinical practice. In order to do this, teachers need to provide their students with a solid foundation in the basic sciences and clinical skills. They also need to instill in their students the importance of lifelong learning and professional development. Additionally, teachers need to create an environment that is conducive to learning, where students feel comfortable asking questions and seeking help when needed. By fulfilling these responsibilities, teachers can play a vital role in ensuring that their students are prepared to meet the challenges of clinical practice.
The physic and physicians as depicted in Plato
“We are fortunate in having had preserved the writings of the two most famous of the Greek philosophers – the great idealist, Plato, whose “contemplation of all time and all existence” was more searching than that of his predecessors, fuller than that of any of his disciples, and the great realist, Aristotle, to whose memory every department of knowledge still pays homage, and who has swayed the master-minds of twenty-two centuries. From the writings of both much may be gathered about Greek physic and physicians…”
Though Hippocrates and Plato lived centuries ago, their work continues to influence modern medicine. The Hippocratic Corpus, a collection of medical texts attributed to Hippocrates, established many of the principles that remain central to medical practice today. These include the oath named for Hippocrates, which laid out the ethical responsibilities of physicians, and the concept of the four humors, which helped to explain the cause of illness. Plato, meanwhile, laid the foundation for the study of physiology with his theories on the nature of the soul. He also advocated for a holistic approach to medicine, which takes into account not only physical symptoms but also psychological and social factors. Though their ideas have been refined over time, the work of Hippocrates and Plato remains an important part of the history of medicine and greatly influenced William Osler.
The leaven of Science
“Biology touches the problems of life at every point, and may claim, as no other science, completeness of view and a comprehensiveness which pertains to it alone. To all whose daily work lies in her manifestations, the value of a deep insight into her relations cannot be overestimated. The study of biology trains the mind in accurate methods of observation and correct methods of reasoning, and gives to a man clearer points of view, and an attitude of mind more serviceable in the working-day-world than that given by other sciences, or even by the humanities. Year by year it is to be hoped that young men will obtain in this Institute a fundamental knowledge of the laws of life”
The leaven of science has been at work in medical education for more than a century. In the early days of scientific medicine, students were taught the basic principles of anatomy, physiology, and pathology. They learned to conduct physical examinations and to use the laboratory to diagnose disease. As new discoveries were made, they were incorporated into the curriculum. Today, students receive a comprehensive education that includes not only the basic sciences but also clinical rotations in hospitals and clinics. The leaven of science has transformed medical education from a narrow focus on the human body to a broad understanding of health and disease. With this knowledge, medical students are prepared to provide the best possible care for their patients. Osler played a pivotal role in medical education over the last century and is regarded by some as the father of modern medicine.
Teaching and Thinking
“The greatest art is in the concealment of art, and I may say that we of the medical profession excel in this respect. You of the public who hear me, go about the duties of the day profoundly indifferent to the facts I have just mentioned… You take it for granted that if a shoulder is dislocated there is chloroform and a delicious Nepenthe instead of the agony of the pulleys and paraphernalia of fifty years ago. You accept with a selfish complacency, as if you were yourselves to be thanked for it…”
Today, medicine is more advanced than ever before. We have a greater understanding of the human body and how to treat illness and injury. We have access to powerful drugs and sophisticated medical technology. Nevertheless, in many ways, we are still living in the dark ages. We still rely on trial and error to find new treatments. We still don’t have cures for many diseases. In some ways, modern medicine is more complacent than ever before.
Internal medicine as a vocation
“I wish there were another term to designate the wide field of medical practice which remains after the separation of surgery, midwifery, and gynæcology. Not itself a specialty (though it embraces at least half a dozen), its cultivators cannot be called specialists, but bear without reproach the good old name physician, in contradistinction to general practitioners, surgeons, obstetricians, and gynæcologists. I have heard the fear expressed that in this country the sphere of the physician proper is becoming more and more restricted, and perhaps this is true; but I maintain (and I hope to convince you) that the opportunities are still great, that the harvest truly is plenteous, and the labourers scarcely sufficient to meet the demand”
The history of internal medicine is long and complex, dating back to ancient times. In the early days of medicine, internal organs were thought to be the seat of disease, and treatments were focused on correcting imbalances in the body. This approach continued for centuries, until the advent of modern medicine in the 19th century. At that time, doctors began to focus on identifying and treating specific diseases, rather than trying to restore balance to the body as a whole. This shift marked a major turning point in the history of medicine, and internal medicine became its own distinct field of study. Since then, internal medicine has continued to evolve, keeping pace with the ever-changing landscape of modern medicine. In many ways, William Osler contributed to the development of this deeply cerebral aspect of medicine.
Books and men
“It is hard for me to speak of the value of libraries in terms which would not seem exaggerated. Books have been my delight these thirty years, and from them, I have received incalculable benefits. To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all. Only a maker of books can appreciate the labours of others at their true value”
Sir William Osler emphasizes the importance of bedside medicine in medical education. Thus countless hours of study in the library pales in comparison to the immense wealth of expertise that can be gained by seeing patients on the wards and in the clinic. This still remains a timeless warning for every medical student. In medical school, textbooks play an essential role in education. They provide students with a comprehensive overview of the topics covered in each course and offer reliable, up-to-date information on the latest medical research. However, textbooks are not the only source of information for medical students. In addition to lectures and class discussions, students also rely on hospital rotations, clinical experiences, and research projects to develop their knowledge and skills. While textbooks provide a foundation for medical education, they are only one part of the educational process.
By studying and appreciating the pearls highlighted in “aequanimitas”, medical students can better appreciate the qualities of a good doctor.
This summary is based on the philosophy and original writings of William Osler MD and FRS. [Regius Professor of Medicine, Oxford; Honorary Professor of Medicine, Johns Hopkins University, Baltimore]
Reference
- Macnalty AS. Osler at Oxford. Arch Intern Med (Chic). 1949;84(1):135–142.
- Osler, William (1914). Aequanimitas : with other addresses to medical students nurses, and practitioners of medicine. London: H.K. Lewis.
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