“Apply yourself to thinking through difficulties—hard times can be softened, tight squeezes widened, and heavy loads made lighter for those who can apply the right pressure.”
— Seneca, On Tranquility of Mind
The practice of medicine can be an emotionally draining endeavor. As physicians, we are pulled between the competing interests of patients, the administration, and colleagues. As the demands and pressure of the job increase, it becomes easier to build a hard shell of detachment in order to protect our egos.
Perhaps a colleague just got a raise or a family member is demanding an unreasonable treatment. Maybe a family member is sick or you just discovered that a new hospital policy will severely affect your work flow. The variety of stresses, desires, challenges, competition, and disappointments that exist in our work can severely hamper our ability to practice high quality medicine. Sooner or later, it can sap the joy from our daily lives as well.
When I start to feel that work is becoming a struggle, I turn to Hellenistic philosophy of Stoicism. Now it is important to clarify that Stoic philosophy is not the same as stoic in the colloquial sense, which is enduring a hardship or pain without complaining or expressing feeling.
Rather, Stoicism is the practice of striving for virtue, its highest good and path to happiness, while understanding the world through reason and not emotion. If practiced consistently, it teaches us to work towards the four cardinal virtues of self-mastery, courage, justice, and wisdom. Further it reminds us not to put our value in the factors, people, or situations outside of our control. All we can truly influence is how our minds perceive and respond to the external world.
Stoicism has been practiced by leaders throughout history. The Roman emperor, Marcus Aurelius, whose book, Meditations, is the classic poster child of a philosopher-leader. But the founding fathers of the United States, George Washington and Thomas Jefferson, were admirers and practitioners too.
Today, numerous professional athletes, business leaders, and politicians turn to Stoicism to achieve success and contentment in their work and lives. Below I have compiled eight quotes from ancient Stoics, which will not only give you a better idea of the philosophy but will also demonstrate how it can help you be a better and happier doctor.
“How many have laid waste to your life when you weren’t aware of what you were losing, how much was wasted in pointless grief, foolish joy, greedy desire, and social amusements—how little of your own was left to you. You will realize you are dying before your time!”
— Seneca, On The Brevity of Life
How often do we get distracted from what is important in our lives when we get caught up in hospital politics or gossip? How much time do we lose when we let ourselves get upset over what others think of us? How much smaller do we feel when we envy what others have? Does any of this actually matter? We have all had the experience of reflecting on a problem that we had a few months prior and realizing how silly it was to have been so consumed by it. More often than not, when we misplace our energy on the trivial, we are only wasting our own time.
“Don’t set your mind on things you don’t possess as if they were yours, but count the blessings you actually possess and think how much you would desire them if they weren’t already yours. But watch yourself, that you don’t value these things to the point of being troubled if you should lose them.”
— Marcus Aurelius, Meditations
Maybe a co-worker has a more expensive car or a bigger house. Maybe a fellow resident has more publications than you. Maybe your classmate was accepted into the residency you wanted to attend. While envy is a natural human emotion, do not let it control you. Instead of focusing your thoughts on what you do not possess, be grateful for what you do. You have been blessed to practice in a highly sought after profession. Be proud about what you have achieved. Many others would trade places with you in a heart beat.
“First off, don’t let the force of the impression carry you away. Say to it, ‘hold up a bit and let me see who you are and where you are from—let me put you to the test’ . . .”
— Epictetus, Discourses
Do you remember seeing that intern struggle? Perhaps he did not know the correct medication or they struggled with learning the EHR. What was your reaction? Did you immediately write him off as “one of the bad ones”? Or did you hold your judgement and wait to learn a little more about him? When we quickly make first impressions about the people we work with, the consultant, the nurse, the tech, even the patient, we can often be wrong. Before you make a snap judgement, ask yourself if you actually know what you think you do.
“If you find something very difficult to achieve yourself, don’t imagine it impossible—for anything possible and proper for another person can be achieved as easily by you.”
— Marcus Aurelius, Meditations
Impostor syndrome is a common feeling in many physicians. I have looked upon the accomplishments of other doctors and wondered how I might ever measure up. I notice that they came from brand-name universities and published in renowned journals. And I wondered to myself, “How can I ever achieve what they have? I don’t have the same pedigree.” But then I have to remind myself that it is all about the perspective. Do I want to consider that I am just not good enough? Or do I want to reframe the challenge, adopt a growth mindset, and ask what can I do to make myself better?
“If anyone can prove and show to me that I think and act in error, I will gladly change it—for I seek the truth, by which no one has ever been harmed. The one who is harmed is the one who abides in deceit and ignorance.”
— Marcus Aurelius, Meditations
Even the best physicians make mistakes. So when you inevitably do, accept it and vow to yourself to improve. Sometimes we do not know the answer or we need to be reminded how to perform a task. Take the lesson in stride. If you show that you can be taught and can handle your errors in stride, you will set a positive tone for your colleagues. Whenever I am not sure about what to order or a medication dose, I often ask a medical student to look it up and teach me. I make sure that they know I am being sincere. It makes then doubly proud to help and to teach their senior. You will show that you are more interested in self-mastery than you are in ego preservation. This also emphasizes that education in medicine never stops.
“That’s why the philosophers warn us not to be satisfied with mere learning, but to add practice and then training. For as time passes we forget what we learned and end up doing the opposite, and hold opinions the opposite of what we should.”
— Epictetus, Discourses
And as you continue in this practice of lifelong learning, it is not sufficient to just go through the motions. Active learning and deliberate practice are the keys to continued excellence. Read the journals in your specialty, listen to the latest medical education podcasts, and attend the conferences. It is also helpful to mentally rehearse or actively practice procedures or situations that you might encounter. Do not take information at face value but dig deeper and ask yourself why is it so.
“Won’t you be walking in your predecessors’ footsteps? I surely will use the older path, but if I find a shorter and smoother way, I’ll blaze a trail there. The ones who pioneered these paths aren’t our masters, but our guides. Truth stands open to everyone, it hasn’t been monopolized.”
— Seneca, Moral Letters
For the rebels and the innovators, this one is for you. Of course I have great respect for giants in medicine that have paved the way. I will heed their advice and learn as much as I can from them. But that does not mean I won’t try to optimize and improve on their lessons. Medicine is meant to be iterative. We learn from the greats that came before us, but so much of medicine is still unknown. You have a chance to seize opportunity make your mark. Nothing is set in stone.
“I’m constantly amazed by how easily we love ourselves above all others, yet we put more stock in the opinions of others than in our own estimation of self. . . . How much credence we give to the opinions our peers have of us and how little to our very own!”
— Marcus Aurelius, Meditations
This final quote perfectly encapsulates one of the main tenets of Stoicism. While you cannot control the actions of another person, you can control your perception and therefore your reaction. When we let another person’s comment or opinion affect our self-esteem, then we transfer our power to them. How ironic is it when we say we have self-love and yet we constantly betray that love by honoring the judgements of others? Often we make the mistake of caring what others think and thinking that they care.
Working in healthcare and medicine can be difficult. But it can also be incredibly rewarding. Stoicism offers poignant reminders and advice on how to deal with challenging people and situations. Like all things, it requires patience and practice. By growing your self-awareness, by elevating your opinion of yourself over others, and by staying open and limiting your ego, you can give yourself a fantastic opportunity for learning and growth. As Seneca’s quote from the introduction indicates, it just takes a little pressure.
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