Humility

Abstract

Humility is a virtue worth considering in the daily activities of the surgeon's practice. How can we teach humility to future generations of surgeons and bring about its recognition within their professional duties? That is not a simple task but needs to be addressed.

A fictional example illustrates a situation in which humility might be an appropriate response. Humility, it has been said, “is the foundation of the spiritual edifice” []. Blaise Pascal stated, “Do you wish people to think well of you? Don't speak well of yourself.” All these characteristics of human behavior need to be incorporated into the education of the surgical professional. In closing, be humble and patients and colleagues will discover the strength of your character.

“Humility is the virtue all preach, none practice, and yet everybody is content to hear.” John Shelden [[1]]

Let me begin by saying that according to Kant, Gandhi, and many Western and Eastern religions, humility is a central virtue [[1], [2], [3]]. Christian texts, particularly those of St. Thomas Aquinas, refer to humility as the center of spiritual life annexed to the prime virtue of prudence [[1]]. Apart from being a basic religious tenet, humility is a virtue especially helpful to all human beings, to all of us. How can we specifically bring this virtue to the consideration of surgeons to aid in the betterment of patient care?

Surgeons do not typically exude humility in their undertakings, either in the operating room or in their practice, probably because of the perceived necessity of demonstrating self-assurance, self-command, poise, confidence, and the recognition of possessing superior knowledge in the performance of the operative act.

Surgeons are not trained to be humble by design. They are trained to prize their skills and solve problems. How can we then modify this overconfident culture and still demonstrate the positive elements of the surgical persona? How can we effectively introduce humility in the surgeon's career without eliminating qualities necessary for superior care?

All these questions, though important enough, do not have a readily available answer. One thing we do know is that humility is an essential virtue to possess and nurture [[1], [2], [3], [4], [5]]. We also know that humility can be taught by example as many other virtues have been taught in the past [[6], [7], [8], [9], [10], [11]]. Finally, we know that humility will bring a fuller and more accomplished professional and personal life to the practicing surgeon. To understand the value of humility, consider the following clinical scenario, though fictional, to reflect the origin and value of humility in the life of the practicing surgeon.

Many were gathering around the main office of Chief Surgeon, Peter Hansicker. He was to report on the findings of the greatest development that one could ever expect, the transplantation of a human brain. Could that be possible? A great number of great surgeons had tried before with no success! The Chief was eager to present his findings and those of his surgical team of twenty-five professionals, who had connected the blood circulation to the whole brain successfully. The patient, a perfectly healthy 25-year-old adult male had suffered multiple strokes with extensive brain damage due to associated unresectable brain tumors. The prognosis was grim, even devastating, until a unique, normal brain from a 30-year-old with an irreversibly damaged heart and severely injured abdominal organs, which did not permit his realistic survival, became available for brain organ donation. Appropriate arrangements had been made, the donor brain was successfully transplanted, and the recipient had begun to show some muscle movement. Initial recognition of preliminary positive advances was at hand.

As Chief Hansicker moved out into the press room to describe the latest developments regarding the case, he fully realized that this case was too premature to present to the rest of the world. The worried and conscientious surgeon turned around and returned to his office without facing the attentive, eager journalists. His reasons were clearly dependent on something he believed was not ready for public consumption. There was no doubt that happiness was abundant without arrogance. Here the virtue of humility was very much in evidence.

• Was the surgeon right in claiming modesty?

• Was his attitude of humility correct?

• Should he actually have told the world what he had done?

• Should he have succumbed to the pressure of the hospital's public relations team to claim the first case of brain transplant?

• Should he have waited until knowing whether or not the patient had responded to therapy and was able to walk out on his own?

• Should he have waited until several of these cases had made brain transplantation a reality?

In answering some of these critical questions, I think the Chief Surgeon was right when he refused to face the press under the circumstances previously mentioned. I think his attitude was correct and reflected the strength of his principles. I think he was correct in applying modesty to his patient's care and not allowing glittery lights to overshadow his view. I think he defended his presence and well-being by not succumbing to the continuous harassment of the department of public relations. I think it would be right to wait until the patient had responded to treatment. Finally, I think he was conservative and attempted to study the role of the physician in the support of all the personalities involved.

How would you present your findings to the public in an era where lack of humility and increased visibility are the norm? A combination of common sense and modesty should be the common denominator. The first-of-anything event is not always the best moment to convey news that might be premature in nature. Time and judgment associated with humility are the best advisors under these conditions.

Humility is not only reflected in the appearance of extraordinary cases, such as the one referred to here. Humility is more frequently expressed in common life events. Humility is a virtue of daily life, one that is exhibited in every aspect of the professional career.

How can we teach young generations of practicing surgeons the positive trait of humility? It is not an easy task, but it can be done if examples are presented as ways to anchor and cement the good will of this important behavioral quality. If young, aspiring specialists see that the mature professional respects others, gives them their place in society, and presents his/her findings in a realistic and unpretentious way, these actions will carry enormous support to engender humility as part of their daily work. Let's approach life in this manner and expect a positive and highly human return from all involved.