Greek philosophers: stoics and health care

Heraclitus of Ephesus, a Greek philosopher, wisely advised, “The only constant in life is change.” Under normal, nonstressful circumstances, we would all agree that change is part of life; yet, we act surprised when change happens.

If we learned anything during the past 2 years dealing with the ever-changing face of the COVID-19 pandemic, it is that change is truly the only constant. Daily routines, practices, work flows, and everything else around us changed not once but several times, and they continue to change. Humanity was attacked by an invisible enemy, and the losses were unprecedented. Health care faced challenges that exceeded our preparedness and perhaps even questioned our situational awareness. Health care providers were asked to stretch beyond their limits and adapt to a new change in how they care for patients and themselves in the presence of the pandemic before they could adjust to the previously imposed change. There were more questions than answers about what was coming next. Hospital admission surges led to shortages in resources and in countries ordering lockdowns to preserve the capacity of their health care systems. Delays in diagnosis and treatment of other conditions unfortunately contributed to excess deaths in 2020. These challenges should not have been a surprise, though, given that health systems were found to be the lowest performing area of overall pandemic preparedness by the 2019 and 2021 Global Health Security Index. Another aspect that should not have been dealt with as a “surprise” is that viruses do mutate, sometimes faster than our employed means of dealing with the offenders or the diseases caused by them. Well, thankfully, we did adapt; we became innovative and resourceful, but mainly operating under reactive rather than proactive modes. Health care was not prepared for a pandemic of such magnitude; we did not see it coming.

The ancient (and modern) stoics practiced premeditatio malorum on a daily basis: the premeditation of the evils and troubles that might lie ahead, an exercise of thinking ahead and imagining how things can go wrong at any time so that we are not caught by surprise. A little under 2 years since the COVID-19 pandemic practically took over our daily activities, economy, education, and health care, among others, the White House plan titled American Pandemic Preparedness: Transforming Our Capabilities was released in September 2021.¹ It is an ambitious proposal that aims to better prepare us for the next pandemic and will require Herculean efforts and tremendous resources. The proposal calls for shoring up defenses against a pandemic by seeking to maximize vaccine and therapy use, sharpening health care's situational awareness, and emphasizing intergovernmental coordination. In the past, such efforts fell short in delivering what they proposed, making this proposal even more critically important in ensuring an effective and timely response to the next pandemic threats that are the “new normal.” Let us be stoics and practice premeditatio malorum as we prepare for the next big change, which is the constant in life.1, 2, 3