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ABSTRACT Humility is the medical virtue most difficult to understand and practice. This is especially true in contemporary medicine, which has developed a culture more characterized by arrogance and entitlement than by self-effacement and moderation. In such a culture, humility suggests weakness, indecisiveness, or even deception, as in false modesty. Nonetheless, an operational definition of medical humility includes four distinct but closely related personal characteristics that are central to good doctoring: unpretentious openness, honest self-disclosure, avoidance of arrogance, and modulation of self-interest. Humility, like other virtues, is best taught by means of narrative and role modeling. We may rightly be proud of contemporary medical advances, while at the same time experiencing gratitude and humility as healers.
IN HIS STORY ENTITLED "Toenails," the surgeon Richard Selzer (1982) warns readers that total immersion in medicine is wrongheaded. Rather, to ensure their own health, doctors should discover other passions that permit them periodically to disconnect from medical practice. Selzer's surgeon character devotes hisWednesday afternoons to the public library, where he joins "a subculture of elderly men and women who gather . . . to read or sleep beneath the world's newspapers" (p. 69). Among these often eccentric personages is Neckerchief, an arthritic man in his 80s who suffers from severe foot pain. His toenails, never trimmed because of his inability to reach them, have grown so long that they curve beneath his toes and dig into the skin when he walks.When the surgeon learns of Neckerchief 's problem, he rushes back to his office, picks up a pair of heavy-duty nail clippers, and returns to the library where, with Neckerchief perched on a toilet in the men's room, he trims the man's nails.This results in immediate pain relief. Subsequently, the surgeon brings his nail clipper to the library everyWednesday and often performs the same service for other homeless eccentrics, like Stovepipe and Mrs. Fringes.
When I present this touching story to medical students, they respond immediately to its humor and compassion.They consider the surgeon a role model of unpretentiousness.They enjoy the way he punctures the balloon of medical arrogance. But even though we discuss the story in the context of professional virtue, they're very reluctant to apply the word humility to his character or behavior.
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