Humility: the primary virtue of a good doctor

The humble man perceives the distance between suffering and death

Iris Murdoch, The Sovereignty of Good

Humility is elusive; in uttering the word, virtue slips away. There is a risk that the writer, in defining humility, assumes a lofty moral position.¹ Indeed, humility is not a virtue that doctors claim; to do so would suggest arrogance, the opposite of humility. Western culture celebrates individuality, celebrity, success and competition, where humility may appear unfashionable.¹ Moreover, the word humility resembles humiliation. And yet, I argue that humility is the primary virtue of a good doctor.²

What is humility?

Humility is derived from the Latin humus = ground, to be humble is to be grounded. Humility may be defined as ‘a lowly self-opinion; modesty or meekness’.³ However, this narrow definition does scant justice to the complexity and value of this virtue. Humility requires us to value our own worth appropriately while accepting our helplessness, fallibility, moral frailty and acknowledging our relative insignificance in the universe.⁴

We perceive the world from our own point of view, often prioritising our own needs and desires. In clinical practice, an ethical stance demands we override this egoism and remove bias. Humility provides a means of achieving this difficult goal.⁴ It allows a doctor to engage with a patient, acknowledging that their needs are as worthy of consideration as her own. Humility, like empathy, is a relational construct which varies in differing contexts and times.^5,6 In adopting an other-orientated focus, humility moderates the power differences between a doctor and her patient. A humble approach protects us from a narcissistic sense of entitlement which can lead to the disrespectful treatment of a patient or colleague.⁴

Commonly specified features of humility include⁷:

• Accurate self-assessment

• Acknowledgement of one’s limitations and errors

• Openness to other ideas

• Viewing one’s accomplishments in perspective

• Lower self-focus

• Appreciating other people

Why value humility?

Humility is valued in many religions, but in this paper, I interrogate the virtue from a secular perspective.⁸ Some argue that humility is the fundamental ethical virtue upon which the other virtues rest.^2,4 Humility protects us from feelings of entitlement and arrogance. It embraces a deep self-awareness of our own limitations and opens us to the other person’s views. Humility is of particular value when a doctor’s beliefs or values are challenged by cultural differences.

Humility promotes solidarity and teamworking by reminding us that we all share the same flawed human nature.⁸ It promotes respect for others, generating a mindset that is open to possibility and fostering solidarity.

Humility, like empathy and kindness, is a construct which connects doctors and patients.⁹ In situations of stress, the humble doctor maintains her other-orientated perspective and so promotes positive emotions in the patient.⁵ Authors have identified a strong connection between humility and helpfulness.⁴ Perceiving a doctor as humble invites a patient into a closer trusting relationship.⁵ Conversely, arrogant doctors are difficult to approach or to confide in. People with humility focus less on themselves, are less defensive, behave more generously, are kinder and are not as concerned with impressing other people.¹⁰

Challenges for humility

Humility should not be confused with lowliness, which involves rejecting one’s own true worth.¹¹ Humility teaches us to be content with what we are and includes an appropriate level of self-worth.

The question arises as to whether great people can be humble?⁴ Wright suggests that the core of humility is the understanding that no matter the greatness of a personal accomplishment, no one is fundamentally more special than anyone else and therefore not entitled to special treatment in everyday life.⁴ Some authors distinguish between healthy self-esteem associated with successful interpersonal relationships and the narcissistic self-aggrandisement associated with interpersonal conflict.⁸

The context of the clinical encounter can alter how a doctor or patient presents themselves. Humility as a relational construct may be affected by stress, grief and trauma.⁵ Humility is a state that we experience in our relationships which can, with experience, stabilise into a basic trait, or virtue, that continuously informs our behaviour.⁴

Humility as a virtue is threatened by a number of vices such as arrogance, vanity, egoism narcissism, domination and selfish ambition.⁴

Cultivating humility

Parents and teachers can foster humility in children by indicating that although they are special, they are not fundamentally more special than anyone else. Conversely parents who spoil children may nurture a narcissistic outlook which undermines humility.¹² Bill Bryson, in a short speech at a graduation ceremony, reminded graduates, ‘Remember you are special people, but also remember that there are seven billion other special people in the world’.

Humility, like other virtues, may be cultivated by exposure to positive role models. Medical students are inspired by clinical role models who take an interest in them and are prepared to share their vulnerability.¹³ It is important that students are able to access such humble role models. The culture or ambience of the medical school or workplace may have a profound effect on whether this particular virtue is valued.¹³

Working in palliative care may cultivate humility. Care of dying patients is a humbling experience for the healthcare professionals involved in caring, easing suffering and witnessing dying with dignity and respect.¹⁴ Humility allows doctors to abandon futile treatments and to stay with patients despite feeling powerless and helpless to change the outcome.¹⁴ Collective humility may exist within a multidisciplinary team working caring for dying patients and for each other. Those professionals privileged to work in end-of-life care learn from patients, families and from each other.

Medical education and practice often encourage competition: grades, awards and league tables incite colleagues to compare themselves with each other. At first sight, such competition may seem to conflict with humility since to be competitive is to be unconcerned about the interests of others. However, the humble doctor may excel, not in order to do better than others but to fulfil their own abilities in patient care.⁴

Gerber suggests that humility may be developed when in awe of one’s surroundings.¹⁵ When contemplating a beautiful sunset for example, we are able to see ourselves in a proper perspective, making us aware that we are a small part of an imperfect world. Wielenberg suggests that humble people have internalised their limitations and relative insignificance, so humility permeates their ethical life without spending time consciously aware of it.⁸

Conclusion

In her thoughtful book, Humility, Wright reflects on the foundational nature of the virtue. She asserts that a person with humility is able to escape the force of her own self-centredness and bias to experience the pull of the other’s needs as strongly as she does her own.⁴ Montaigne, brings a sense of balance, it is better he feels, to be moderate, modest and a little vague.¹⁶ Humility leads to a deep connection and a responsibility for others manifest today in the work of doctors and other healthcare professionals, caring for the sick and vulnerable, sometimes at a risk to themselves.