"Aequanimitas" Redux: William Osler on detached concern versus humanistic empathy.

Recent critics make William Osler "the father of cool detachment" in medicine, largely because of his "Aequanimitas" address emphasizing objectivity and imperturbability. Closer analysis suggests that Osler's aequanimitas resembles more nearly the metriopatheia of later Stoic philosophy than the apatheia of the early Stoics. A previously unpublished memoir clarifies at least in part Osler's motive for teaching control of the "medullary centres" to minimize facial expression: he did not want to frighten patients, who typically had serious illnesses for which he lacked effective therapy. Twenty-first century challenges to medicine as a profession differ substantially from those of Osler's era. Physicians and educators must focus more closely on the tension between detached concern ("competence") and humanistic empathy ("caring") if medicine is to thrive as a learned profession as opposed to a technical service, a commodity to be bought and sold like any other.