Humanism, Humility, and Physician Leadership

As have all of you in recent months, I have come across many examples of unhappy situations for others and self-centered opinions from others. By the same token, there also have been innumerable examples of incredible acts of caring for others and countless illustrations of unifying, selfless behaviors from others.

At my core, I realize this represents how we are now living and being with the essence of human nature. Collectively, we are on a level of being human in ways we perhaps had not previously experienced or perhaps had drifted away from as a result of the routine in our daily lives. Periods in history such as this provide an opportunity to reflect on being human.

One of the privileges of my position with American Association for Physician Leadership is the opportunity to participate on a variety of expert panels and advisory groups. An interesting trend I have noticed is the focus on solving tactical issues such as supply chain challenges and expanding our focus on how we can best care for our fellow humans and how we can continue to better provide true patient-centered care. A common reflection often emerges on the essential need for strong, visionary leadership and an unwavering commitment to improving healthcare delivery practices in a more humanistic fashion.

So what is humanism? One definition is “any system or mode of thought or action in which human interests, values and dignity predominate” (https://www.dictionary.com/browse/humanism ). Other versions expound on secular, non-religious aspects and a lack of supernatural components. Humanist beliefs usually stress the potential value and goodness of human beings, emphasize common human needs, and seek solely rational ways of solving human problems.

Taking it further, in a May 2013 presentation on spiritual humanism to the Hangzhou International Congress, philospher Tu Weiming stated, “A comprehensive and integrated vision for the survival and flourishing of humanity in the 21st century must take into consideration self, community, nature, and heaven as four distinct but yet interconnected dimensions of human self-understanding.” He goes on to describe that as “an agenda for further exploration, spiritual humanism seeks an integration of body and mind, a fruitful interaction of self and community, a sustainable and harmonious relationship between the human species and nature, and a mutuality between the human heart and the Way of Heaven.”

I prefer this latter approach to humanism because of its spiritual overlay and the added recognition of community and nature. I tend to believe that a more holistic approach to humanism is better suited to the evolving issues in our world and across our societies as a whole. While I am not an overly religious person per se (being primarily spiritual in focus), I recognize that religion continues to be an essential component in people’s lives, regardless of the form of religion being followed; notably, all religions, irrespective of origin, carry critical components of humanism in their readings.

In an invited commentary on humanism in medicine in the August 2019 issue of Academic Medicine, George Thibault states beautifully, “Humanism has been at the core of the medical profession since its inception, and it has been a foundation throughout modern history for political and community values .  . . . This work to humanize medicine follows the principles of humanism — putting patients (human beings) at the center of focus; promoting a better understanding of the human experiences of both patients and clinicians; deriving professional goals and actions from the real needs of patients; applying reason to better solve the problems in healthcare; and using science to devise ways to better help patients maintain health.”

If humanism is “any system or mode of thought or action in which human interests, values and dignity predominate,” in some ways, if we’re not careful, this can sound a bit like, “It’s all about me.” So, where does humility fit in?

Humility, it turns out, is equally challenging to synthesize simply. There is no one specific definition, and there are numerous types and attributes related to humility. It is not just about being humble! For example, some definitions state that humility requires the characteristics of self-awareness, commitment to self-improvement, appreciation for others, vision for a different future, personal integrity, and complete honesty at all times.

Neel Burton, MD, in Psychology Today (June 30, 2018), says, “Humility is more about subduing one’s ego and willingly acknowledge that self-importance is less worthy of regard than group achievements.” Bradley Owens and David Hekman, in the April 2015 Academy of Management Journal, define humility as “…consisting of three important pillars: a willingness to view oneself accurately, an appreciation of others’ strengths and contributions, and teachability, or openness to new ideas and feedback.”

Don Davis and colleagues have written on distinguishing intellectual humility (IH) from general humility (GH), stating in the June 2015 Journal of Positive Psychology, “GH involves (a) an accurate view of self and (b) the ability to regulate egotism and cultivate an other-oriented stance; IH is a subdomain of humility that involves (a) having an accurate view of one’s intellectual strengths and limitations, and (b) the ability to negotiate ideas in a fair and inoffensive manner.”

Melanie Tervalon and Jann Murray-Garcia have suggested the term “cultural humility” as opposed to “cultural competency” or “cultural sensitivity” to guide clinicians in serving the needs of diverse populations. Bringing attention to the internal workings of the clinician, they suggest in their May 1998 article in the Journal of Health Care for the Poor and Underserved that cultural humility is a practice committed to a lifelong process of self-evaluation and self-critique.

In a Perspectives piece for The Lancet in 2008, Sayantani DasGupta describes the concept of narrative humility: “Like the writer, whose work depends on entering into the imagined suffering of equally imagined characters, so too is the doctor intertwined inextricably with ‘assumed’ or ‘rhetorical’ suffering…the stance from which we witness stories of suffering must be one of narrative humility. As careful interviewers and witnesses, we become invested in, wrapped up with, and, yes, coauthors of our patient’s illness narratives, but we cannot ever claim to comprehend the totality of another’s story, which is only ever an approximation for the totality of another’s self. Narrative humility is a response to efforts at clinical mastery.”

DasGupta suggests that narrative humility acknowledges that “…our patients’ stories are not objects that we can comprehend or master, but rather dynamic entities that we can approach and engage with, while simultaneously remaining open to their ambiguity and contradiction, and engaging in constant self-evaluation and self-critique about issues such as our own role in the story, our expectations of the story, our responsibilities to the story, and our identifications with the story — how the story attracts or repels us because it reminds us of any number of personal stories… the witnessing function, so crucial to doctoring, becomes a mutual one, supporting and nourishing both individuals, while enabling a deeper, more fruitful clinical relationship.”

What about leadership in this context? Traditional charismatic leadership identifies leaders through their ability to articulate a vision, empower followers to work toward achieving the vision, demonstrate charismatic behavior, and set high performance expectations for followers. The expected outcomes from this form of leadership are numerous and include increased follower motivation, enhanced follower esteem, higher performance from followers, and presumed trust in the leader. It is recognized, unfortunately, these types of leaders often act in self-interest, exploit others, disregard others, and reject others who do not comply with the leader’s agenda.

In contrast, leaders who exhibit humility and a high degree of humanism often achieve better performance results from their followers — and for their organizations. They do so by serving the collective interests of others to develop and empower followers, are follower-oriented, and tend to be altruistic in their orientation. These individuals have a socialized power motive, which reflects a concern for the group and a focus on group goals, an understanding of others, and exercising influence for the benefit of others.

In their article in the November 2009 issue of Journal of Leadership and Organizational Studies, Rob Nielson and colleagues contend that these types of leaders are humble in their approaches and coin the term “effective socialized charismatic leaders.”

The three pillars of humility from Owens and Hekman, and the importance of a leader’s willingness to constantly improve and excel, incorporated with being teachable, were also identified as critical elements of humility associated with leadership by Verl Anderson and Cam Caldwell in Humility as Enlightened Leadership (2018). Humble leadership is highly relational, focused on creating group trust, and based upon creating a culture that inspires everyone to collaborate to produce an optimal outcome, according to Edgar and Peter Schein in Organizational Culture and Leadership (2016).

Pulling it all together in a meaningful context, as Anatole Broyard writes in Intoxicated by My Illness and Other Writings on Life and Death (1992), “Not every patient can be saved, but his illness may be eased by the way the doctor responds to him — and in responding to him, the doctor may save himself. But first he must become a student again; he has to dissect the cadaver of his professional persona…It may be necessary to give up some of his authority in exchange for his humanity, but as the old family doctors knew, this is not a bad bargain. In learning to talk to his patients, the doctor may talk himself back into loving his work…by letting the sick man into his heart…they can share, as few others can, the wonder, terror, and exaltation of being on the edge of being, between the natural and the supernatural.”

Remember, leading and creating significant change in healthcare is our overall intent as physicians. AAPL focuses on maximizing the potential of physician-led, interprofessional leadership to help create personal and organizational transformation that benefits patient outcomes, improves workforce wellness, and refines healthcare delivery internationally.

We must all continue to seek deeper levels of professional and personal development and to recognize ways we can each generate constructive influence for one another at all levels. As physician leaders, let us become more engaged, stay engaged, and help others become engaged.

Exploring and creating the opportunities for broader levels of positive transformation in healthcare is within our reach – individually and collectively.