Sue Wootton
Doctor wellbeing has been in the news lately, with the recent ratification by the World Medical Association of a new clause to the Declaration of Geneva (the modern Hippocratic Oath). The change was proposed and promoted by Queentown’s Dr Sam Hazledine, following concern at the very high level of burnout experienced by doctors. The old clause read, “The health of my patient will be my first consideration.” The new clause reads:
I will attend to my own health, wellbeing and abilities in order to provide care of the highest standard.”
Just over a century ago, Canadian physician Sir William Osler, sometimes called the father of modern medicine, gave several addresses to graduating doctors and nurses. He often focused on the importance of keeping well so as to give good care to others. He advised that each practitioner develop a Way, a guiding path of regular habits. One such sustaining habit was to start a “bedtime library” and read for half an hour every evening:
Every day do some reading or work apart from your profession. I fully realize, no one more so, how absorbing is the profession of medicine … but you will be a better man and not a worse practitioner for an avocation.”
Another was to keep physically fit with exercise, good food and adequate sleep:
To keep the body fit is a help in keeping the mind pure.”
To avoid being overwhelmed by never-ending work, he advocated “the habit of living for the day only, and for the day’s work.” He called this habit “Life in day-tight compartments”. Today we might call it “mindfulness”.
In 1913, Osler explained his method to students at Yale University:
I stood on the bridge of one of the great liners, ploughing the ocean at 25 knots. “She is alive,” said my companion, “in every plate; a huge monster with brain and nerves, an immense stomach, a wonderful heart and lungs, and a splendid system of locomotion.” Just at that moment a signal sounded, and all over the ship the watertight compartments were closed. “Our chief factor of safety,” said the captain.
“In spite of the Titanic,” I said.
“Yes,” he replied, “in spite of the Titanic.”
Now each of you is a much more marvellous organization than the great liner, and bound on a longer voyage. What I urge is that you so learn to control the machinery as to live with ‘day-tight compartments’ as the most certain way to ensure safety on the voyage. Get on the bridge, and see that at least the great bulkheads are in working order. Touch a button and hear, at every level of your life, the iron doors shutting out the Past – the dead yesterdays. Touch another and shut off, with a metal curtain, the Future – the unborn tomorrows. Then you are safe – safe for today!”
For Osler, self-control was the key to successfully managing ‘life in day-time compartments’. He had high standards in this regard, and a puritan outlook by today’s standards: “Realize that you have sixteen waking hours, three or four of which at least should be devoted to making a silent conquest of your mental machinery.” Osler thought that it was vital to “cultivate the power of peaceful concentration”:
The failure to cultivate the power of peaceful concentration is the greatest single cause of mental breakdown … One of the saddest of life’s tragedies is the wreckage of the career of the young collegian by hurry, hustle, bustle, and tension – the human machine driven day and night, as no sensible fellow would use his motor.”
He quotes psychologist and philosopher William James: “Neither the nature nor the amount of our work is accountable for the frequency and severity of our breakdowns, but their cause lie rather in those absurd feelings of hurry and having no time, in that breathlessness and tension, that anxiety of feature and that solicitude of results, that lack of inner harmony and ease … ”
Osler’s metaphors are old-fashioned now. Rather than talk of ‘conquering’ the mind’s ‘machinery’, we’d probably employ an evolutionary neuro-biological image and speak of quietening ‘monkey mind’. But however it’s done, daily practice of the Way, said Osler, was the key to wellbeing in a busy, stressful career:
Shut close in hour-tight compartments, with the mind directed intensely upon the subject in hand, you will acquire the capacity to do more and more, you will get into training; and once the mental habit is established, you are safe for life.”
Sue Wootton is co-editor of Corpus.
Source:
- Osler, William. “A Way of Life” and other Addresses, with commentary and annotations. Eds. Shigeaki Hinohara and Hisae Niki. Durham and London: Duke UP, 2001.
Read another piece on Corpus about Sir William Osler: Start at once a bedtime library
Try these too:
Making I contact with the doctor
Attentive curiosity: a methodology of presence
Other related articles can be found by clicking on a subheading such as Medical Humanities or Essay on the Corpus home page.
It is a dramatic profession. I would love to see ‘highest standard’ replaced with something critical that will instil the fact that it is often life and death that you are responding to and negotiating for your patient. This is a massive sacrifice and of what my limited knowledge is seen by those in the doctor’s world as a privilege. How do you emphasise this because ‘highest standard’ is almost misleading in this context. It in no form articulates the degree of investment of the doctor in this relationship with the public. Please leave the urgency and compassion conveyed in the former wording while encompassing the essential need for the doctor to retain their sanity, health and application. Maybe have these isolated as different clauses equally important. I have not seen the full document, just what I have seen on this forum. So I may be surprised that these ideals are already spoken in this. My fear is that we will become more selfish as an example to a currently very vulnerable society.
Sincerely.