WHEN I was battling the demons of severe depression and suicidal ideation, the word resilience was mentioned … well, more stated at me.
You’re just not resilient enough … if only you were stronger … you’re just not able to cope … you know not everyone is cut out to be a doctor … have you considered another career? … you are too sensitive, too self-reflective, that’s your problem.
I was a 20-year plus veteran in the profession however. A little late for this advice, although I had considered a career change in order to save my own life. It was far better to be alive and see my children grow up than return to the very place that was destroying me.
Junior residents experience this from senior doctors still today – “it’s what we went through, what we had to put up with, therefore, so should you”.
At the time when I was deeply unwell, they were not the words of support I required at all. What I needed was the opposite, but the blame had been clearly laid at my feet. I was the failure, it was not the system I was in. The system was failing to accept some responsibility.
So preoccupied was I with this concept of resilience that I even got a tattoo as a permanent reminder of what I lacked or thought I lacked. It’s now a reminder to me that I am resilient and I was at that time.
What is resilience? The word is thrown around a great deal these days – I would suggest a little too often in medicine.
Derived from the Latin word resilio – to rebound, bounce back, recoil – in modern terms, resilience may be viewed as the ability to bounce back from adversity.
The school my children attend uses this word often – its importance in future life, the avoidance of being what they call a “helicopter parent”. In this environment, resilience is built in a supportive community, with family support that is loving. It’s this connection – the sense of belonging – that is important. Resilience is not the domain solely of the individual but is a shared process. Resilient children develop this skill with a sense of control over their lives. They can learn from failure, that they matter as human beings, and that they have strengths that are valued.
Sharing adversity is also important. As the saying goes, “in prosperity, our friends know us; in adversity, we know our friends”. The recent acts of terror, both here and overseas, rather than breaking communities apart, have only strengthened them. It’s the bonded community and individual resilience that has developed.
What about my resident years, early on?
This will not be much different to that of many others. I still recall my first Christmas day at work in a country hospital. Not only was I at work and largely alone in an emergency department but I had to deal with the death by road trauma of a young child. I remember it every Christmas, as that family’s day will never be the same again. There were long hours, poorly supported rotations, on-call, sleep deprivation, fear of making mistakes – all of which is all too familiar to any doctor.
A friend of mine, a retired police detective, said to me the other day that it wasn’t the first rape victim, or gun drawn on him, but the accumulated many moments that eventually make your cup overflow. The analogy holds true in medicine. The long hours, the on-call with sleepless nights, the need to turn up at work the next day notwithstanding, unsocial hours, compassion fatigue, burnout, the increasing fear of litigation, the difficulty in maintaining connections outside of work, the increasing violence against health care workers and the increased workplace bullying are familiar to us.
These are coupled now with the top-down targets, both time and fiscal, often set by individuals that rarely set foot in the clinical domain.
Medicine takes a bright group of people who are caring, self-reflective and sensitive – is this not what one requires in a doctor? – and places them in a hostile and increasingly unforgiving environment. The result is an increase in mental health issues, especially in that first year of residency. It’s hardly the place to thrive rather survive, and where does that leave the very people we wish to look after?
In all my years in medicine, I have learned very little from the very people that demand resilience of me.
I have spent many hours in therapy, using self-help and other means to enhance my strength toolbox.
These things are partial help, however, because the environment I am in still does not allow for bouncing. It’s far easier to bounce on a trampoline than concrete, and medicine has too much concrete.
The development of resilience is not just the domain of the individual, or the worker in the health care system. It’s a community effort, within the micro- and macro-environment in which we work. It requires connections, both social and professional. It’s so much more than a seminar or workshop, or another PowerPoint presentation, and much more than a simple platitude about doing more.
As humans we seem to be hardwired to see disaster and bad things, and this is so much more evident in doctors. We are too often good at delivering criticism to our peers, but not giving praise or support. For the leaders who are reading this, reflect on your past few interactions.
My daughter, who recently dislocated her finger, required a hug not some resilience-building exercise, reassurance that she would be okay. This is better than saying “suck it up”.
I consider myself very resilient; in fact, the evidence is that most doctors are.
Outside work, I have completed some of the world’s toughest ocean swims. My resilience has not been questioned in the water, but it’s developed with a strong team around, a sense of support that if I get into difficulties, I will be okay. That allows me to push to the extremes and beyond. I used performance psychology and hypnotism to enhance my performance and deal with setbacks. Most, if not all, elite sports people use them. Why not medicine?
Resilience requires health professionals to have and feel a connection, a sense of belonging. It requires a system that allows one to learn from mistakes without fear of reprisals, but with positive suggestions about how to improve. It requires systems to develop individual signature skills and work on deficiencies. It requires positive peer support, and realistic goal setting, especially around time and money. It needs to help doctors learn the skill of asking for support, and then support them when one does. It needs to give doctors room and time to allow resilience to develop – down time, exercise, outside connections and rest, with adequate sleep.
I know from my own personal point of view that I have worked very hard to enhance my strengths. In fact, a major step in my recovery was to stop blaming myself and protect myself from the system’s issues. I now ask for a system that better allows me and others to bounce.
We are still a long way away from this.
Dr Geoffrey Toogood is a cardiologist and a long time advocate for mental health. He has swum the English Channel. He came up with the idea of crazysocks4docs day.
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