Beyond Osler's Equanimity: Encountering Akira Kurosawa's "Red Beard" as a Post-Oslerian Model of the Good Physician through Cinematic Narrative Medicine
Wilson Ricketts, MD, UCLA, Los Angeles, CA; and Kalei Hosaka, MD, UCLA, Los Angeles, CA
“In the first place, in the physician or surgeon no quality takes rank with imperturbability.” [1] This description of the ideal doctor, enunciated by Sir William Osler in his famed commencement address “Aequanimitas” looms large in the social imaginary of modern medicine. Although it is reductionistic to distill Sir William’s vast body of written work and countless aphorisms down to a single syllogism, this quotation typifies the Oslerian ideal of a good doctor for many contemporary physicians. Within this framing, physicians should possess an unemotional and cool rationality, have the ability to detach themselves from stressful, high stakes situations, and, above all, maintain a nobility of character that allows them to rise above to quotidian concerns of daily life. Equanimity is the highest of virtues.
However, this vision of the ideal physician is afflicted with at least two key problems. First, as Abraham Nussbaum contends, this Oslerian ideal has proven to be an insufficient mechanism for rendering the lived experience of medicine more meaningful and fulfilling in late modern society, illustrated by increasing rates of physician burnout and an ongoing exodus of physicians from the clinical practice. [2] Second, the Oslerian ideal fails to adequately address the social embeddedness of medicine. As Persaud, Butts, and Berger have pointed out, this is specifically apparent with respect to medicine’s historic role of reifying and enforcing systems of racism. Regarding issues of race, the typically verbose Osler was at best curiously silent and at worst an active participant in medicine’s legacy of racism and racialization. [3] In both cases, the ideal of the prototypical doctor as unmoved and detached has served to exacerbate underlying pathologies rather than heal them.
If the ideal of Oslerian “equanimity” is not a viable solution to the contemporary crisis of medical vocation, what alternatives exist? One discipline that has attempted to answer this question is Narrative Medicine. Narrative Medicine is an interdisciplinary endeavor, centered “at the intersection of humanities, the arts, clinical practice, and health care justice with conceptual foundations in narratology, phenomenology, and liberatory social theory.” It aims to “equip clinicians to better comprehend their patients’ experiences and perspectives so as to deliver equitable and effective health care,” establishing vocational patterns that are more just, sustainable, and fulfilling. [4]
In practice, however, narrative medicine often falls short of its lofty ends: medical education is supplemented with trips to art museums, students and residents participate in ad hoc reflection sessions, and faculty members share poems at meetings. Although instances of individual inspiration certainly occur, precious little ultimately changes on a systemic level.
In this presentation, we will argue that narrative medicine’s limited practical efficacy lies not in a deficiency in the the tools of narrative medicine itself but are rather due to the fact that those employing them all too often remain in the thrall of the Oslerian ideal. Frequently, narrative medicine simply reconfigures the Oslerian wheel rather than breaking it – let alone offering a refreshing alternative.
To offer a such an alternative, we will use a narrative medicine approach to engage with a non-Oslerian model of the good physician via an underutilized means: cinema. Through its manipulation of time, image, and emotion, film has the capacity to impact viewers on a pre-cognitive, affective register, allowing them to encounter the stories of individuals and communities with their emotional guard down, providing an opportunity for transformative encounters with non-Oslerian models of the good physician. As our cinematic source text we will use Akira Kurosawa’s 1965 film, Red Beard, in which a cynical medical graduate – a man who embodies several Oslerian traits – undergoes his own transformative vocational journey under the tutelage of the titular master physician, Red Beard. Engagement with Kurosawa’s film will not only provide a theoretical framework for envisioning and embodying a more coherent and whole practice of medicine, but will also offer a therapeutic, affective encounter with a powerful example of a post-Oslerian good physician.
1. Osler, W. (1914) Aequanimitas: With other addresses to medical students, nurses, and practitioners of medicine (2nd ed.). P. Blakiston’s Son & Co. Press.
2. Nussbaum. (2018). The worthless remains of a physician’s calling: Max Weber, William Osler, and the last virtue of physicians. Theoretical Medicine and Bioethics., 39(6), 419–429. https://doi.org/10.1007/s11017-018-9470-z.
3. Persaud N, Butts H, Berger P. William Osler: saint in a "White man's dominion". CMAJ. 2020 Nov 9;192(45):E1414-E1416. doi: 10.1503/cmaj.201567. PMID: 33168766; PMCID: PMC7669299.
4. Columbia division of narrative medicine: https://www.mhe.cuimc.columbia.edu/division-narrative-medicine#:~:text=Narrative medicine is an international,phenomenology, and liberatory social theory.
However, this vision of the ideal physician is afflicted with at least two key problems. First, as Abraham Nussbaum contends, this Oslerian ideal has proven to be an insufficient mechanism for rendering the lived experience of medicine more meaningful and fulfilling in late modern society, illustrated by increasing rates of physician burnout and an ongoing exodus of physicians from the clinical practice. [2] Second, the Oslerian ideal fails to adequately address the social embeddedness of medicine. As Persaud, Butts, and Berger have pointed out, this is specifically apparent with respect to medicine’s historic role of reifying and enforcing systems of racism. Regarding issues of race, the typically verbose Osler was at best curiously silent and at worst an active participant in medicine’s legacy of racism and racialization. [3] In both cases, the ideal of the prototypical doctor as unmoved and detached has served to exacerbate underlying pathologies rather than heal them.
If the ideal of Oslerian “equanimity” is not a viable solution to the contemporary crisis of medical vocation, what alternatives exist? One discipline that has attempted to answer this question is Narrative Medicine. Narrative Medicine is an interdisciplinary endeavor, centered “at the intersection of humanities, the arts, clinical practice, and health care justice with conceptual foundations in narratology, phenomenology, and liberatory social theory.” It aims to “equip clinicians to better comprehend their patients’ experiences and perspectives so as to deliver equitable and effective health care,” establishing vocational patterns that are more just, sustainable, and fulfilling. [4]
In practice, however, narrative medicine often falls short of its lofty ends: medical education is supplemented with trips to art museums, students and residents participate in ad hoc reflection sessions, and faculty members share poems at meetings. Although instances of individual inspiration certainly occur, precious little ultimately changes on a systemic level.
In this presentation, we will argue that narrative medicine’s limited practical efficacy lies not in a deficiency in the the tools of narrative medicine itself but are rather due to the fact that those employing them all too often remain in the thrall of the Oslerian ideal. Frequently, narrative medicine simply reconfigures the Oslerian wheel rather than breaking it – let alone offering a refreshing alternative.
To offer a such an alternative, we will use a narrative medicine approach to engage with a non-Oslerian model of the good physician via an underutilized means: cinema. Through its manipulation of time, image, and emotion, film has the capacity to impact viewers on a pre-cognitive, affective register, allowing them to encounter the stories of individuals and communities with their emotional guard down, providing an opportunity for transformative encounters with non-Oslerian models of the good physician. As our cinematic source text we will use Akira Kurosawa’s 1965 film, Red Beard, in which a cynical medical graduate – a man who embodies several Oslerian traits – undergoes his own transformative vocational journey under the tutelage of the titular master physician, Red Beard. Engagement with Kurosawa’s film will not only provide a theoretical framework for envisioning and embodying a more coherent and whole practice of medicine, but will also offer a therapeutic, affective encounter with a powerful example of a post-Oslerian good physician.
1. Osler, W. (1914) Aequanimitas: With other addresses to medical students, nurses, and practitioners of medicine (2nd ed.). P. Blakiston’s Son & Co. Press.
2. Nussbaum. (2018). The worthless remains of a physician’s calling: Max Weber, William Osler, and the last virtue of physicians. Theoretical Medicine and Bioethics., 39(6), 419–429. https://doi.org/10.1007/s11017-018-9470-z.
3. Persaud N, Butts H, Berger P. William Osler: saint in a "White man's dominion". CMAJ. 2020 Nov 9;192(45):E1414-E1416. doi: 10.1503/cmaj.201567. PMID: 33168766; PMCID: PMC7669299.
4. Columbia division of narrative medicine: https://www.mhe.cuimc.columbia.edu/division-narrative-medicine#:~:text=Narrative medicine is an international,phenomenology, and liberatory social theory.