In pursuit of equanimity

Issue: BCMJ, vol. 65, No. 8, October 2023, Page 279 President's Comment
Dr Joshua Greggain
Dr Joshua Greggain

Many physicians I admire possess calmness, levelheadedness, and composure in difficult situations—a state of equanimity if you will—that I wish to emulate. Whereas I can get riled up or irritated when things aren’t going well, they can take on an immeasurable amount of stress, work, or tasks with a countenance I don’t always possess. It makes me wonder how they make it happen. Is it innate? Is it trained? Or do they choose this demeanor?

In health care, there seem to be innumerable overwhelming issues, everything from climate emergencies to ER closures, from wait times for specialist services to an ongoing lack of access to family physicians, along with a digital space that is complex and fraught with challenges. We see these issues firsthand in our local communities, we hear about them from colleagues, we read about them in the news, and I personally receive emails about them from doctors on a weekly basis. The multitude of ongoing and agonizing issues contributes to our individual and collective suffering. Some feel this pain more acutely than others, in part because of their circumstances or their response to the initial harm. We hurt when our patients hurt, we suffer because the system is suffering, and our hearts ache because our colleagues’ hearts ache. I want to pursue how to mitigate, minimize, or eliminate this secondary suffering. Is equanimity the answer?

As the Buddha says, “In life, we can’t always control the first arrow. However, the second arrow is our reaction to the first. The second arrow is optional.” I came to understand this parable through a conversation with a friend about health issues we each suffered this summer. She had an orthopaedic injury that forced her to be non-weight-bearing for weeks, while I experienced a diverticular abscess while working in a remote location. We were not lamenting the physical pain we endured but rather the emotional toil and the feeling of ineptness as we recovered. The first arrow represents an event that can cause pain—in our case the physical injury. The optional second arrow represents our reaction to the event; depending on how we choose to respond, it can bring as much pain and suffering as the first arrow or more. Undoubtedly, we usually find ourselves dealing with consequences from the second arrow more so than the first. What resonates with me is that minimizing suffering and pursuing equanimity is not about denying the initial pain but about finding composure in how to respond emotionally.

There are moments when I want to scream about the many issues impacting us, our colleagues, our profession, our patients, and our communities. Over the past several months, numerous friends and colleagues were affected by ER closures, rampant wildfires, and the inability to seek refuge from one or more overwhelming circumstances. Those are all first arrows, and each of them hurts. But I also know many of those individuals stepped up to support one another despite the difficult situations they were facing, whether by staying late to admit evacuated patients from the territories or by opening their homes to those who were displaced, and that is the second arrow. We share a level of composure and a genuine desire to help one another, and we endeavor to do so with a level of equanimity. We know this is the right and good thing to do. Conceivably, it will also help lessen the suffering of the second arrow the next time we face a negative event and get hit with an arrow ourselves.
—Joshua Greggain, MD
Doctors of BC President


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Joshua Greggain, MD. In pursuit of equanimity. BCMJ, Vol. 65, No. 8, October, 2023, Page(s) 279 - President's Comment.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

Leave a Reply