Tag Archives: medical ethics

Resilience

Female doctor demonstrates resilience overcomes adversity and views life positively.


Three other philosophers and I recently devoted eight hours of Socratic Dialogue to the topic of resilience. Using this method, participants blend philosophical inquiry with personal experience in a search for truth. Our goal was to define resilience, not from somewhere “outside” ourselves (i.e., from books, teachings, etc.), but from within, based solely on the lived experience of one of the participants. 

Our “dialogue” differed from a “discussion” in that we spent our time investigating (rather than convincing), listening to ourselves and each other (rather than taking positions), and questioning (rather than answering) in order to come up with a definition that might apply to virtually all persons regardless of circumstances (before starting, we chose to focus solely on modern humans/Homo sapiens).

Our collective inquiry concluded that resilience is the manifestation of positive adaptation resulting in personal growth in an adverse situation. To this, we added the stipulation that resilience is a process that implies decision making (a cognitive means by which one chooses to believe, act, or feel from among possible alternatives) and flexibility of mind (the ability to adapt one’s thoughts, emotions, and behaviors to changing situations).

I have since been thinking about how this definition applies to health care providers. Medicine is an emotionally and cognitively demanding profession. Sometimes it is also physically exhausting. There are strenuous work schedules, long hours, ethical dilemmas, and pressures from working with scientific uncertainty. There are legal considerations, the burdens of teamwork and an occasional forced collegiality, as well as the reality of medical and surgical errors. Workplace-related political traumas, bureaucratic overload, interprofessional drama, and the burdens of complex decision-making are not easily overcome. With the addition of repeated exposures to human suffering and loss, particularly in the absence of adequate support from family, friends, colleagues, or institutions, a health care provider’s emotional, mental, and psychological states are prone to dysfunctionality. 

Burnout, for example, touches almost half of all physicians in the United States. This affects patient outcomes, institutional efficiency, professional longevity, and overall well-being. Several studies show that physicians are at greater risk of burnout (characterized by symptoms of distress and dissociation) and have lower satisfaction with work-life integration than the general population, after controlling for age, sex, relationship status, and hours worked per week.

Resilience, manifested as positive adaptation in the face of significant adversity, is more than showing grit or being emotionally “tough.” According to our group’s definition, it is also a potentially life-changing or “perspective-altering” phenomenon closely linked to personal growth and self-awareness. It is, therefore, both intrapersonal and relational. It allows health care providers to engage deeply with patients and those around them without being consumed by adverse situations. It supports cognitive clarity under pressure and demonstrates the ability to experience distress without becoming dysfunctional, while maintaining the capacity to reframe adverse situations in ways that engender positive feelings, actions, and thoughts.

  • Van Rossem K. What is a Socratic dialogue? Filosofie Jrg 2006;16(1)48-51.
  • Luthar SS, Cichetti D, and Becker B. The construct of resilience: A critical evaluation and guidelines for future work. Child Development 2000;71 (3):543-562.
  • Panagioti M, Panagopoulou E, Bower P, et al. Controlled interventions to reduce burnout in physicians:
  • a systematic review and meta-analysis. JAMA Intern Med. 2017;177(2):195-205. doi:10.1001/jamainternmed.
  • West CP, Liselotte ND, Sinsky C et al. Resilience and burnout among physicians and the general US population. JAMA Network Open 2020;3(7):ee209385. doi:10.1001/jamanetworkopen.2020.9385.

Psychological Safety Matters

Clinician reassuring a patient to promote psychological safety during a bronchoscopy discussion


Psychological safety describes people’s perceptions of the consequences of taking interpersonal risks in a particular context, such as the workplace. Quantitative and qualitative results from the business and psychology literature document its positive impacts on organizational performance, learning, and cultural change. 

Experts say psychological safety operates at the individual, group, and organizational levels. Some examples of a psychologically safe work environment are those in which employees might speak up without fear of retribution, readily admit and document their mistakes, or learn on the job without fear of punishment or humiliation. In health care, a psychologically safe environment enhances patient safety, facilitates quality improvement mechanisms, promotes learning behaviors that mitigate the negative impact of hidden curricula, and fosters greater individual well-being.

The purpose of this short essay, however, is not to focus on organizational environments, the value of teamwork, or how to cultivate specific leadership skills. My goal is to reflect for a moment on why health care providers should help their patients feel psychologically safe during each encounter. By doing this, they can help prevent patient harm, foster patient resilience, enable interprofessional collaboration, and support diagnostic excellence.

When patients feel psychologically safe, they communicate openly. They are more likely to disclose sensitive information about their medical history, symptoms, and behaviors without the fear of being judged or reprimanded. They are more likely to share results of their own research about their illness, and perhaps, view health care providers more as partners and advocates than authoritative decision-makers. Such engagement is essential to patient-centered care, which focuses on understanding and meeting patient needs and preferences. It is a significant part of the World Health Organization’s 2021-2030 Global Patient Safety Action Plan to eliminate avoidable harm in health care. 

In my experience, actions of unconditional acceptance accompanied by empathy and/or compassion also contribute to psychological safety and create an atmosphere that fosters resilience and greater patient well-being. As a “third party” other than family and friends, health care providers have a unique opportunity to affect, hopefully positively, the physical, mental, and emotional health of their patients. This includes engendering feelings of hope and optimism. Each patient-provider encounter, therefore, is potentially life-changing for the injured or ill person. By initiating or reinforcing their patient’s resilience, health care providers alter the patient-illness dynamic and contribute even more to their patient’s comfort, happiness, and sense of security.

It goes without saying that patients who feel psychologically safe are more likely to trust their health care provider’s attitudes and recommendations. They might see themselves more as active participants in decision-making processes, and as true partners in a multidisciplinary team approach to combat, control, or accept their state of health. In a psychologically safe environment, clinicians, patients, and their families can explore diagnostic or prognostic uncertainty with less trepidation, revisit initial hypotheses when clinical, laboratory, or imaging data conflict, and approach second opinions or further subspecialty referrals with greater confidence. Psychological safety thus contributes positively to interprofessional collaboration and the quest for diagnostic excellence.

Actions that help generate an environment in which patients feel psychologically safe are essential to optimizing the effects of each patient encounter with health care providers. They are separate from the organizational or systems-based changes necessary to build a psychologically safe culture for a health care facility’s physicians, students, administrators, and other employees. Because they are personal and often private, they connect the internal morality of medicine with the complex yet fragile operational realities of health care delivery. 

  1. Kumar, Santhi. Psychological Safety. CHEST, 2024. Volume 165, Issue 4, 942 – 949.
  2. Edmondson AC and Lei Z. Annu. Rev. Organ. Psychol. Organ. Behav. 2014. 1:23–43
  3. Global Patient Safety Action Plan. https://www.who.int/teams/integrated-health-services/patient-safety/policy/global-patient-safety-action-plan; 2021-2030. Accessed October 30, 2025.
  4. Fukami T. Patient engagement with psychological safety. Dialogues Health. 2023 Sep 17;3:100153. doi: 10.1016/j.dialog.2023.100153. PMID: 38515810; PMCID: PMC10953965.

Risk normalization vs. an ethos of safety

Rock cliff in Zion showing risk normalization and need for safety
Photo courtesy H. Colt

I recently returned from a trip to Zion National Park, in the beautiful state of Utah, where a tragic accident led to the death of a 58-year-old man who fell while rappelling in Pine Creek Canyon. Known for its massive sandstone cliffs, giant slot canyons, and challenging hiking trails, the park is a famous destination for rock climbers and canyoneers alike.  Just weeks earlier, in my home state of California, a 23-year-old experienced rock climber named Balin Miller made international news when he accidentally rappelled off the end of his rope after completing an ascent of the famous granite wall called El Capitan, in Yosemite National Park.

The problem with climbing accidents, whether from inattention, weather, climber and equipment error, or plain bad luck, is that they are unforgiving and often fatal. That is why so much attention is paid to accident prevention and to raising awareness about the risks of taking shortcuts or engaging, intentionally or unintentionally, in risky behavior. Miller, for example, was descending only a short distance to dislodge his equipment bag that had become stuck in a crack. He forgot or neglected to tie a knot in the end of his rope, ran out of line, and slid off the end to his death.

Accidents like this prompt me to think about the concept of risk normalization, also referred to as “normalization of deviance,” which describes how risky behaviors or operating in potentially dangerous conditions can become increasingly acceptable over time because of the absence of negative consequences. In other words, “repeated exposures to hazards without consequence lowers the perception of danger.” Think about texting while driving, bypassing infection control protocols, riding your motorbike without a helmet, or taking a casual approach to a risky activity. 

For individuals, organizations, and society-at-large, any drift in behavior, cultural acceptance of potentially risky behaviors without appropriate safeguards, and reduced perception of hazards are all linked to risk normalization. I am amazed, for example, at the lingering resistance to using checklists to assure patient and procedure-related safety in interventional pulmonology. Also, I am intrigued by hundreds of videos of successful complex bronchoscopic interventions presented at national conferences or on WhatsApp, but very rarely is there a discussion of “close calls” or of something that went wrong. 

Risk normalization is one of several invisible epidemics that threaten our overall well-being. It is fostered by complacency, desensitization, and an unwillingness, at times, to speak truth to power. It is a menace to professionalism that affects our ability, or reflects an unwillingness, to reason, and it represents a cultural drift away from vigilance and the ethos of safety and prevention. Health care environments, specifically in procedure-related aspects of healthcare delivery such as interventional pulmonology, are fertile settings for its development. 

Diane Keaton and altruism in the movies

trailer image of movie Marvin's room and film with Diane Keaton about altruism


Diane Keaton passed away on October 11, 2025. She was seventy-nine years old. Versatile and classy, she defined the roles she was given rather than letting those roles define her. During a fifty-five-year movie career that included one Academy Award (in Woody Allen’s Annie Hall, 1977) and numerous star-billings alongside male movie greats such as Al Pacino, Jack Nicholson, and Warren Beatty, Ms. Keaton, through all her complex characterizations of femininity on screen, both dramatic and comedic, made a significant mark on American cinema.

In one of her lesser-known films, Marvin’s Room (directed by Jerry Zaks from a screenplay by Scott McPherson), she portrays Bessie, a staunch and self-sacrificing woman who has spent the last twenty years caring for her mute, bedridden, multiple-stroke victim father, Marvin (Hume Cronyn), and her ailing aunt, Ruth (Gwen Verdon). Bessie’s life changes drastically when she learns she has leukemia and requires a bone marrow transplant. The rest of the film is a poignant exploration of family dynamics, responsibility, and the value of selfless caregiving in the context of renewed relationships Bessie establishes with her estranged sister, Lee (Meryl Streep) and Lee’s two dysfunctional children, the emotionally volatile teenager, Hank (Leonardo DiCaprio) and his ten-year-old brother, Charlie (Hal Scardino), all of whom may be eligible donors for a procedure that could save Bessie’s life. 

The film draws attention to the high emotional toll of individual altruism rooted in a sense of duty, family responsibility, and unselfish love displayed by family caregivers. Today, and for the foreseeable future, many medical conditions that were once fatal are survivable. An increasing number of people, therefore, find themselves taking on the usually unpaid, self-sacrificial roles of caring for sick or disabled relatives. Results from a recent study in the United States, for example, showed that more than 59 million Americans provide care for an adult with a complex medical condition or disability, and another 4 million adult family members care for a sick or disabled child. In the United States, despite help from job-protective legislation such as The Family and Medical Leave Act (which provides twelve weeks of unpaid leave, continued health benefits, and guaranteed job reinstatement for those working in companies with more than fifty employees), these responsibilities render caregivers extremely vulnerable to unemployment, job and opportunity loss, financial hardships, emotional burnout, and physical illness.

In Marvin’s Room, as in real life, altruism cycles back as Bessie, the self-designated family caregiver, becomes the person in need. In addition to dealing with her own severe illness and the consequences of her new vulnerabilities, she must struggle with the problem of who will replace her if or when she is no longer able to provide caregiving services to her loved ones. Sadly, this reversal of fortune is not uncommon. Yet, the realities of caregiving environments are rarely the focus of medical or surgical consultations, which understandably target disease diagnosis and treatment.

Not all patients have a champion who can knowledgeably advocate for their well-being. Films like Marvin’s Room are a gentle reminder that it is a moral obligation and professional duty for physicians and other health care providers to take it upon themselves to inquire about caregiving responsibilities for all patients, and, if possible, to offer support, assistance, and tangible solutions that might help family caregivers lessen their burdens. In so doing, health care providers not only demonstrate compassion, selflessness, and commitment, they also create opportunities for acts of medical altruism that express our humanity.

Medical Altruism: It’s not simple

Doctors demonstrating medical altruism


The concept of medical altruism, which is central to health care delivery and both patient and physician well-being, is extraordinarily complex. Filled with nuance and interconnected layers, even its definition is problematic. Usually understood as a dynamic, context-dependent virtue, medical altruism can be viewed as a commitment by medical providers (physicians, nurses, and other providers) to use their power, position, privilege, and knowledge in the best interests of others (their patients) even at personal cost and varying degrees of effacement of self-interest. Seen in this light, medical altruism includes in its essence altruism (“other-regarding,” as coined by nineteenth-century French philosopher August Comte), and the morally obligatory trait of altruistic beneficence (as described by American ethicists Edmund Pellegrino and David Thomasma), which goes beyond the principles of benevolence (wishing others well) and nonmaleficence (not doing others harm).  

Regardless of whether medical altruism is approached from a philosophical, psychological, theological, evolutionary, professional, or cultural perspective, it must be distinguished from the concept of altruism in medicine. While medical altruism is individual and profession-centered, altruism in medicine is viewed as a commitment of the health care collective, including its professional organizations, institutions, economics, sociocultural environment, populations, and political systems to address healthcare based on altruistic rather than egoistic or self-centered values. Altruism in medicine, therefore, might also apply to selfless patient-originated decisions to donate blood, stem cells, organs, and other tissues, as well as healthcare provider-originated decisions to volunteer for humanitarian activities, combat global inequities, or share knowledge, time, and experience in degrees that are above and beyond what is expected of their professional duties and, in the case of physicians, their social contract with society. 

Further complicating discussions of medical altruism and altruism in medicine is the rapidly changing face of medical practice and health care environments. There are obvious tensions regarding the value and sustainability of selfless motivation, just as there are significant vulnerabilities and systemic weaknesses of existing health care institution-based frameworks and societal policies regarding professionalism and what constitutes ethical medical practice in a technology-driven, soon to be AI-dominated twenty-first century. These and other elements relating to altruism will be the focus of several future reflections on Colt’s Corner. Please subscribe and share.

  • Pellegrino, ED and Thomasma DC. The virtues of medical practice. Oxford University Press, 1993.
  • Creuss SR and Creuss RL. Professionalism and Medicine’s social contract with society. Virtual Mentor 2004;6(4):185-188.