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ABSTRACT
Recent critics make William Osler "the father of cool detachment" in medicine, largely because of his "Aequanimitas" address emphasizing objectivity and imperturbability. Closer analysis suggests that Osler's aequanimitas resembles more nearly the metriopatheia of later Stoic philosophy than the apatheia of the early Stoics. A previously unpublished memoir clarifies at least in part Osler's motive for teaching control of the "medullary centres" to minimize facial expression: he did not want to frighten patients, who typically had serious illnesses for which he lacked effective therapy. Twenty-first century challenges to medicine as a profession differ substantially from those of Osler's era. Physicians and educators must focus more closely on the tension between detached concern ("competence") and humanistic empathy ("caring") if medicine is to thrive as a learned profession as opposed to a technical service, a commodity to be bought and sold like any other.
SOME YEARS AGO I WATCHED a cardiologist approach a dyspneic and apprehensive patient who appeared to be in pulmonary edema or cardiogenic shock. She was surrounded by a team of residents and medical students. "Mrs. Jones," my colleague announced, "I'm Dr. Blank. I'm gonna put this catheter in your heart." He did.
Such scenarios, critics suggest, typify much of what has gone wrong with medicine: too much technology, too little empathy. My colleague exuded confidence but made little or no effort to resonate with the patient's emotions. Some critics trace this pattern of behavior to Sir William Osler (1849-1919), the most famous physician in the English-speaking world at the turn of the 20th century, considering him "the father of cool detachment," the originator of an "Oslerian equanimity" antithetical to empathie caring. Osier's reputation in this regard rests mainly on his 1889 "Aequanimitas" address to graduating medical students at the University of Pennsylvania. Here is the passage that elicits the most criticism:
The first essential is to have your nerves well in hand. Even under the most serious circumstances, the physician or surgeon who allows "his outward action to demonstrate the native act and figure of his heart in complement extern," who shows in his face the slightest alteration, expressive of anxiety or fear, has not his medullary centres under the highest control, and is liable to disaster at any moment. I...