Category Archives: Philosophies

Personality, Patients, and Personal Care


The Five Factor model of personality traits, also known as The Big Five, was conceived by psychologists to help explain features of human thinking, feeling, and behavior that are shared across all human populations regardless of race, gender, age, or language, differing only in the degree of their individual manifestations.  Research shows this hierarchal model, which organizes personality traits according to five dimensions: conscientiousness, extraversion, agreeableness, neuroticism, and openness to experience, is applicable across observers and cultures.

Understanding how these traits affect medical practice is important, not only to the physician patient relationship, but also to nurturing self-care, and to recognizing how certain strengths and vulnerabilities might impact teamwork, clinical care, overall performance, and professional well-being. Acquiring an awareness of these traits might also prompt initiatives that are crucial to personal growth during the lifetime of every practitioner. 

It is impossible to describe the details of these five dimensions in the space of a few paragraphs, but briefly, openness entails a doctor’s degree of willingness to embrace new ideas, technologies, structures, and perspectives. Conscientiousness might reflect a practitioner’s respect of ethical responsibility, manifesting itself, for example, as dependability and integrity. Extraversion, agreeableness, and neuroticism highlight interpersonal and emotional aspects of medical practice. They contribute to what is also referred to as Emotional Intelligence (EI), which is the ability to recognize, understand, and regulate one’s own emotions as well as the awareness of how those emotions might affect or influence others.

Health care providers face multiple challenges in the workplace, not the least of which are found in their interactions with patients. One often unspoken consequence of these interactions is the deleterious effect of a patient’s death or suffering on caregivers themselves. Being aware of how this manifests itself within the dimensions of The Big Five can be helpful in building personal resilience as well as a capacity for greater empathy and compassion, not only for patients and their families, but also for other caregivers, and importantly, toward oneself.

  • McCrae RR, John OP. An introduction to the five-factor model and its applications. J Pers. 1992 Jun;60(2):175-215. doi: 10.1111/j.1467-6494.1992.tb00970.x. PMID: 1635039.
  • Novikova, I.A. (2013). Big Five (The Five-Factor Model and The Five-Factor Theory). In The Encyclopedia of Cross-Cultural Psychology, K.D. Keith (Ed.). https://doi.org/10.1002/9781118339893.wbeccp054

Vulnerability and Resilience


At a recent pulmonary conference hosted by Sharp Healthcare in San Diego, I had the opportunity to discuss vulnerability and resilience issues in healthcare. One of my goals was to raise awareness about the tragedy of suicide among physicians and other healthcare professionals. Recent studies have shown that suicides are on the rise, and that among female physicians, for example, rates exceed those from among the general population. Registered nurses and health care support workers also have higher suicide rates compared to non-healthcare workers (16 versus 12.6 per 100,000 persons) in the United States. 

Health care providers, especially in high-stress environments and situations, face the risk of emotional exhaustion, moral distress, and burnout. One recent study, for example, showed that at least sixty percent of healthcare professionals feel burned out, costing the US healthcare system more than four billion dollars annually. As we learned during the COVID pandemic, health care systems are also vulnerable to factors such as economic stress, supply-chain disruption, and dwindling resources that can adversely impact their employees’ well-being.

My point, of course, is not the financial burden of this tragedy, but the cause. Vulnerability in healthcare workers’ health is linked for the most part to structural and cultural factors in the medical profession. Long hours, administrative burdens, emotional distress, and the stigma that prevents healthcare workers from seeking professional psychological support are just a few of the factors that contribute to increased risks of burnout, depression, and professional dissatisfaction. Not surprisingly, these might easily overwhelm one’s personal resilience (defined as the ability to cope with and recover from suffering, often in the face of adversity). 

The interconnectedness of resilience and vulnerability underscores the importance of institutional and professional societal structures to strengthen individual coping resources and address systemic contributors that hamper a health care worker’s well-being. It is time that we address these issues explicitly, in journals and national meetings, as well as locally in our medical schools and health care institutions. I am hopeful that, in a collaborative spirit of concern, care, and compassion that extends beyond the patient care arena, the current “younger” generation of health care professionals will give greater value to resilience-building and vulnerability acknowledgment than their predecessors. 

  • Jain L et al. Suicide in Healthcare Workers: An Umbrella Review of Prevalence, Causes, and Preventive Strategies. J Prim Care Community Health. 2024 Jan-Dec;15.
  • West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences, and solutions. J Intern Med. 2018 Jun;283(6):516-529. Epub 2018 Mar 24. PMID: 29505159.

What is ‘Bronchosophy’


Interventional pulmonologists live simultaneously and sequentially in many worlds. One moment, they may find themselves directly responsible for the life or death of a patient with advanced disease; in the next, they might be delivering bad news, making prognoses under uncertain conditions, wrestling with the uncertainties of a novel technology, initiating long-term strategies, or advocating for their approach in a multidisciplinary care meeting. 

Many interventional pulmonologists are naturally curious and enthused to learn how to perform new procedures that require manual dexterity and analytical precision. But the profession demands more than technical skill to truly serve its patients. Equally important are a doctor’s abilities to communicate with clarity, courage, compassion, grace, and humility. Practicing medicine with such depth and professionalism is both a challenge and a virtue. 

It is not surprising, therefore, that bronchoscopy, a fundamental component of interventional pulmonology, is more than just a procedure. It is a way of seeing not only literally into the airways, but also metaphorically into a patient’s life. It is the means by which interventional pulmonologists contribute to another human being’s life story, often at a critical time of their patient’s journey between birth and death. 

More than forty years ago, one of the first bronchoscopies I performed prompted a difficult conversation with my patient about the effects of malignant central airway obstruction on their life and well-being. At that time, most oncologists and pulmonary specialists were still nihilistic about lung cancer treatments, and the value of palliative airway procedures was neither recognized nor accepted. My patient went on to receive chemotherapy and external beam radiation, sadly with little improvement in their symptoms and without a beneficial effect on their quality of life. During those weeks, I learned much from our bedside conversations, including humility. I realized that my ability to see into my patients’ airways granted me the privilege to hear their life stories. What remained was for me to determine the best ways I could help them.  

The results of this experience might be described as bronchosophy (pronounced /ˈbrɒŋ. kəˌsɒf.i or /ˈbrən kasəfi/), which is a term a few of us have used over the years, but has not yet entered common language. Just as philosophy might represent the pursuit of wisdom, truth, and knowledge, bronchosophy represents the pursuit of wisdom in the practice of bronchology. It can be defined as ‘a reflective and principled approach to the art and science of airway examination and intervention, combining technical skill with ethical insight, clinical judgment, and humanistic care.’ In other words, bronchosophy is the cornerstone from which the art and science of bronchology and interventional pulmonology blend with our humanity and heartfelt endeavors to do what is in the best interests of our patients.

Ethics in Interventional Pulmonology


Ethics, from the Greek words ēthos and ēthike philosophia (moral philosophy), is traditionally defined as the study of morality. What ought I do in a particular situation? What are the limits of my responsibility? How do my actions and behaviors relate to the particular norms, expectations, rules, or codes of conduct established by my profession, peers, and society, and how might these affect my community? 

The study of ethics also raises awareness and helps address other questions: Do my actions reflect a moral conscience at the center of my being or a system of thought dependent upon religious or societal models of expected behaviors? What are the emotional consequences if I must choose, in my desire to do what is right, from among potentially opposing ethical concepts, and might I rely on both subjective and objective arguments to justify my decisions? 

The Greek philosopher, Aristotle (384-322 BCE), was himself the son of a physician. He begins his treatise, Nichomachean Ethics, by writing, “Every art and every inquiry, and similarly every action and pursuit, is thought to aim at some good…will not the knowledge of it, then, have a great influence on life?”[i] Since its origins, the ‘art and science’ of bronchology and interventional pulmonology has grown in leaps and bounds. Focus has been on disease states, procedural techniques, training curricula, and how to best apply new technologies. The study of IP-related medical ethics, however, has sadly been neglected, as if medical doctors felt naturally inclined to ethical practices because they went to medical school and wear white coats or surgical scrubs. By no means do I suggest that IP specialists practice unethically. In fact, all the practitioners I know do their best to provide appropriate and competent patient care based on existing scientific evidence and the resources they have available. The practice of interventional pulmonology does, however, raise a variety of ethical dilemmas for which doctors are not necessarily trained, and situations for which doctors may not be fully aware of potential ethical issues at hand.

Therefore, based on my own experience practicing medicine and surgery around the world in diverse settings, my formal training as a medical ethicist, educator, mediator, and philosopher, and my current work as a philosopher practitioner, I decided to add an Ethics section to the Bronchoscopy International website at www.bronchoscopy.org. I have also prepared a first volume (available for free download in PDF form), Introduction to Ethics in Flexible Bronchoscopy, to serve as an introductory text for practitioners and IP specialists in training. My goal is to provide readers with fundamentals from which they may gain perspective to discuss, evaluate, reflect upon, and more readily address ethical issues faced in their daily practice of interventional pulmonology. My hope is to see ethics discussed in yearly training courses, national meetings, and IP societies’ international conferences. I welcome your feedback and hope this text is a helpful addition to other educational materials used by our profession.

[i] The Basic Works of Aristotle. Eds Richard McKeon. The Modern Library, Random House, NY, 2001. Nichomachian Ethics, book I, 1094a. WD Ross trans.