Comments have again morphed into an essay. And, once again, they’re in response to a blog post by Dr. Suneel Dhand: When it comes to positive change, physicians are their own worst enemy. I thought it was excellent and spot-on. My first comment read in part:

When reading this post — before I read the comments — I found myself silently nodding … maybe because I agree with much of what Dr. Dhand has written this past year (here on KevinMD and his blog) … maybe because we’ve been exchanging emails since December … maybe because we’ve spoken and I’ve heard his passion for and commitment to finding solutions on several fronts.

Then I read the comments and had to go back and reread the essay. What did I miss? This sentence stood out. “Perhaps the Internet as a whole is more adept at giving a platform to the voices of the cynics and pessimists, neglecting the silent majority.”

In Tom Brokaw’s book A Lucky Life Interrupted: A Memoir of Hope, he wrote: “I am in awe of the bandwidth — the brain power — it takes to become a physician, the dedication, the imagination and energy, the compassion …” He offered this empirical, astute observation about the challenges in medicine today. “… what will not change is that the delivery of healthcare cannot slow or stop while this is sorted out. We’re attempting to change tires on a semi-trailer truck while going eighty miles an hour.”

I’m grateful for Suneel and all those who try to affect positive change through words and actions, i.e., those changing the tires — most often without “neon orange vests” — to protect them from the cynicism, pessimism, and anger they’re bound to encounter on the road.

A respondent wrote:

Speaking for the cynics, I think most of us have reacted to Dr. Dhand’s posts as we have because we find them superficial, naive, and very typical of the type of thinking that has gotten us into the mess. He may deny it, but he gives voice to the corporate powers that are destroying medicine as a profession.

I replied back:

With all due respect and sincerity, how do you see the huge challenges and problems in medicine today being met and solved? Using the EHR mess as an example, can you provide a couple concrete steps/solutions? Who will enact them?

Words matter. You label yourself a “cynic.” Are you really, or are you a skeptic? I appreciate the need for skeptics on problem-solving teams, but not cynics. (I am talking about lowercase “cynics.”) The Merriam-Webster dictionary defines “skeptic” as “a person who questions or doubts something (such as a claim or statement) : a person who often questions or doubts things.” It defines “cynic” as “a person who has negative opinions about other people and about the things people do; especially : a person who believes that people are selfish and are only interested in helping themselves.”

I freely admit I sometimes get discouraged by the discourse in the comments here … and the New York Times, the Atlantic, Washington Post, Facebook, i.e., pretty much everywhere. (Two exceptions: Humans of New York and Pulse – Voices from the heart of medicine: positive, uplifting, inspiring stuff.) When I do, I go to my safe haven. I go to Sir William Osler.

I Googled “Sir William Osler on cynics” and hit pay dirt! I found a wonderful 1999 article I hadn’t read before by one of my favorite physician authors, Sherwin Nuland. The subject of “The Saint” is Osler. In reviewing the biography written by Michael Bliss (of which he gave high marks), Nuland offered up a few reflections of his own on Osler:

The next sixteen years [at Johns Hopkins] would be a period of immense productivity … His international fame grew, his clinical research flourished, and he was more popular a teacher than ever, if it is possible to imagine such a thing. The atmosphere of joy that he brought to everything he did, and the sense of high purpose that he conveyed, infected students with a love of medicine and an appreciation for the nobility of the calling they had chosen.

Sir William Osler died on December 29, 1919. Nuland wrote: “Osler was dead, but Osler lived on. Although the numbers are now becoming small, medical students and grizzled physicians still occasionally seek inspiration by reading the many essays that he wrote on the medical life. Some are dated, but others are as fresh as the day he put pen to paper.”

The following proves his last point. It’s from an Osler address to students at the University of Toronto in 1903:

To you the silent workers of the ranks, in villages and country districts, in the slums of our large cities, in the mining camps and factory towns, in the homes of the rich, and in the hovels of the poor, to you is given the harder task of illustrating with your lives the Hippocratic standards of Learning, of Sagacity, of Humanity, and of Probity. Of learning, that you may apply in your practice the best that is known in our art, and that with the increase in your knowledge there may be an increase in that priceless endowment of sagacity [sound judgment], so that to all, everywhere, skilled succor [help, relief] may come in the hour of need. Of a humanity, that will show in your daily life tenderness and consideration to the weak, infinite pity to the suffering, and broad charity to all. Of a probity [integrity, honesty], that will make you under all circumstances true to yourselves, true to your high calling, and true to your fellow man.

I enjoyed every word of The Saint, but it was Nuland’s closing paragraph that provided the support and validation I needed when I randomly Googled earlier:

William Osler is a fascinating man whom we need nowadays. In this time of cynicism, it is good to know that the earth can be inherited by those who have faith and trust in the improvability if not the perfectibility of humankind; in this time of bioethical conundrums, it is good to know that patience, good will, and personal morality will untie far more intellectual knots than the disarray of rancor, conflict, and special interests; in this time of great medical miracles it is good, and properly humbling too, to know that there have been other periods of miracles, and yet the ancient problems of health and human happiness remain, bringing new challenges to each succeeding generation. William Osler’s life and his writings tell us of these things, but they are beginning to fade from the experience of all but a few men and women who seek them out. They need to be revived, and he needs to be heard again.

I may not be as thick-skinned as Dr. Dhand, but I ask for honest feedback just the same. Why is there so much rancor and cynicism expressed on the internet, from the New York Times to Facebook to KevinMD and beyond? Would we make these comments out loud if the person we demean was standing in front of us? Would we write such things if we had to use paper and pen and take time to affix a $.49 stamp and mail them? Do we feel better when we sling an especially clever barb?

Simon Sinek gave the third most-watched TED Talk of all-time, over 25.5 million views: How great leaders inspire action. Sinek is an optimist and refreshing 21st-century “leadership” thinker.  His books are close to Osler’s on my shelves. He espouses that trust, cooperation, and human relationships cannot grow digitally. They require human interaction. His words are prominently displayed.

“So much of starting a business or affecting change boils down to the confidence and courage to simply try.”

Ironic postscript: The most optimistic, un-cynical person I’ve come across this century has the surname of “Sinek,” pronounced exactly like “cynic.” How can that not make you smile?

Janice Mancuso is the creator, The Osler Symposia: Weekend Retreats for Doctors & Nurses.

Image credit: rook76 / Shutterstock.com