Are You Anancastic? Just a Little Bit Helps

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By Richard P. Mills, MD, MPH, Chief Medical Editor, EyeNet

As you know, I’m a word guy. I love words that I discover when I’m half paying attention in lectures, when I’m reading erudite books, or trolling the Internet. Sometimes I go searching, like a pig rooting for a truffle, for exactly the right word to use in an Opinion. Never mind that few people have ever used it in conversation or read it in classic literature. The new word is even better when it describes a characteristic that I hold dear, such as compulsiveness. Show me an ophthalmologist, and I will show you somebody who is at least a little anancastic. It’s a human characteristic at least as old as ancient Greece, where anankastikos meant compulsory or coercive. It isn’t derived from the same root as anal (sorry, Freudians), nor is it sarcastic, nor bombastic, nor (thank goodness) Comcastic. But in some fields, anancastic may be fantastic. In order to be successful at patient care, especially surgical care, the physician is required to have scrupulous attention to detail, to embrace compulsiveness. Its close cousin, obsessiveness, often comes along for the ride. Both are subsumed by anancasm. 

I got started thinking about obsessiveness and compulsiveness when I observed people lots younger than myself thumb-drumming text messages on their smartphones. Even though the younger generation seems to lack sustained concentration in a lot of their activities, laser focus is the rule when they’re text messaging. But there’s a serious downside to this type of anancastic behavior. For example, consider the tunnel vision that besets pedestrians while texting. There seems to be an imperative to answer an incoming message right away, as fast as the thumbs can move, even faster than the brain can keep up. I’ve learned that it’s an insult to the sender not to respond immediately. So that is why texting and driving is so dangerous (and why the majority of states have laws against it). First, the driver must furtively glance at the cell-phone display and then hope for a red light, in order to text back. Alas, the light turns green before typing is done, so now it’s several seconds of not looking at the road, or the crosswalk, or the car in front that just stopped suddenly. While anancastic texting behavior may be more prevalent among the young, it has gradually spread to people with children and even grandchildren. People who should know better.

But I digress. I started to explain why being a little anancastic is a desirable trait for an ophthalmologist. Physicians depend a lot on their compulsiveness, not just in the office and operating room but also at home, when they know they should be keeping up with the literature. It isn’t so much about being able to pass the exam associated with maintenance of certification—that can be accomplished with strategic last-minute studying—rather, it’s more about staying informed for our patients’ benefit. Yet the vast majority of patient encounters don’t require information from the latest journals; even physicians who don’t keep up view themselves as excellent at patient care. That’s where the compulsiveness comes into play. It provides the internal motivation to read at least some of the journals, to read EyeNet to fill in the gaps in areas not central to our practices, and to attend meetings where we can bounce our ideas off colleagues. My children think I have a hint of obsessive-compulsive disorder, and maybe I do when it comes to my work. But at least I’m not anancastic about texting.