When I began my work to improve ‘physician engagement’ in a large healthcare organization; the approach to well-being was to give a talk about ‘three good things’. There has been research done in this area that shows finding things to be grateful for is an effective method to both improve and sustain improved mood.
But if the word ‘resilience’ triggers your audience, they turn off and you will not affect them positively. In fact they will be disturbed that this is your approach.
I started by addressing the pain points in the physicians’ work environments. What I encountered was well-meaning mid-level management that was pulled in many directions and tried their best to improve the work environment. Usually, there was little frontline healthcare worker input into these decisions.
Physicians in particular, found meetings a waste of time and felt their opinions didn’t matter. They felt it was leadership’s job to fix the drivers of burnout. Physicians would tell management what needed to be done and wait for it to happen.
Anyone who is responsible for how a system works, knows that you can’t just take one person’s opinion on a solution, implement it and expect all the pieces to easily fall into place. So, I taught management and leadership how to engage their teams to encourage perspectives, avoid those meetings in which a small fraction of participants actually participate, get the investment of the subject experts and those that the decisions affect and make wiser decisions.
“If all leadership does is pluck the pebbles out of their shoes, they miss the opportunity to discover with them, that the better solution is to pave the road. ”
— dme, 2016
My point is, that if we are going to find solutions to the drivers of burnout, we need to learn how to do meetings differently so that they are worthwhile to attend. We need to be intentional about decision-making. We all need to invest in making our work environments better. We need to show up or be satisfied with the solutions that others do without us.
Reasons to Build Individual Resilience
Let’s talk about the ‘R’ words. Yes, there is more to resilience than dragging our way through medical school, residency and starting a practice to get to where we are today. We physicians are one of the most resilient folks that walk the planet; if you define resilience as resistance to adversity.
Resist is the first ‘R’ word. We are like the willow tree that doesn’t give in to the strong winds. It has a hearty root system (our values) and wispy leaves (flexible preferences) so that it can withstand hurricanes and tornadoes.
We compassionately care for patients’ health, while postponing having families, missing family celebrations, despite not having sleep for 36 hours, even when we ourselves are ill, until we can’t anymore!
We all eventually have those events in our lives that result in us ending up on the rumble strip of the highway of life. If you haven’t, give it time. You most likely will lose a parent, face grave illness for you or a loved one, or possibly make a harmful medical error.
I hope that you never have any harm come to your child. These events will challenge your assumptions about the world. This is trauma.
What do you know about managing that rumble strip? Will you end up in the ditch or do you have the skills to get back up on the highway? What are those skills? Who will support you?
When is the best time to build community, learn recovery skills, find practices that restore you? Easy answer, start now! Recovery is the second ‘R’ word.
There is much buzz these days about post-traumatic growth. The pandemic was/is a chronic trauma that challenges/d our worldview and is/was peppered with acute trauma for those of us on the frontline. The third ‘R’ is rise.
How can we rise above and learn from adversity? This takes reflection and intention. How much time do you spend in reflection? I’m not talking about when you are driving home in your default thinking mode, worrying about the people in your life.
Are you being intentional about how you approach your life? Or are you just running the hamster wheel? Do you run Plan Do Study Act (PDSA’s) at home to improve the quality of your relationships?
Do you have someone that can illuminate your moral compass, challenge your thinking, support you to be your authentic self? What are the skills you need to transform your life after trauma?
If I was in an academic position, I would check the hypothesis that physicians excel at resistance to adversity and are average on recovery and rising. There are at least three reasons that building our individual resilience (with respect to recovery and rising) make sense:
1. Gravity
There are many drivers of burnout in our work environments that cannot be changed by us as individuals, our teams collectively or even the leadership in the organization. The solution to healthcare dysfunctions is beyond most of our imaginations, let alone influence. These are what some might call, ‘gravity’ issues. Complaining about gravity is a waste of energy.
Now, joining a collaborative that innovates around how we can care for psychiatric patients in our state has merit and may be effective in the long run. In the moment; getting angry that you can’t find a bed in the state for your pediatric suicidal patient that is not safe at home, is not healthy or effective. You need to be able to think clearly and find a solution that will be the best for the patient. Resilience helps us lift the load of the gravity issues.
2. Shaming Your Colleagues
The second reason not to disrespect offers to build resilience is that vocalizing this further shames those among us that are struggling, that are not doing well on their own. Perpetuating the idea that our colleagues are superhuman and pushing back about resilience sends a message that we should be able to tough it out.
Please recognize that we all have different coping skills. Let others be open to the idea that it is human to feel broken. They are not alone in feeling broken. Do not deny them the space to reach out; the opportunity to become more able to recover from and rise above adversity.
3. You Will Experience Trauma
Good for you, if you are living a blessed life without trauma. This too shall pass. I once was in a conversation where people were sharing big traumas in their lives. A man in his forties told us a story about how during a campaign season, a family member posted something on FaceBook that upset him. Really? Well, you can’t blame him for being blessed.
Every elder in this group told traumatic stories like loved ones with really scary cancer, divorce and children going astray.
We know from neuroscience research that building the pathways to the pre-frontal cortex which happens in resilient practices will help people cope with these catastrophic events. This takes time.
Don’t make the mistake of thinking you are immune to these traumatic events. Open your mind to learning how to integrate mindful practices into your life now! I’m not one to use fear as a motivator, but how about reality? Trauma happens.
Too often we disrespect practices, like mindfulness when we don’t really know much about them. We make assumptions based on experiences we’ve had in the past that we aren’t even aware of. Perhaps in your youth, a respected Sunday school volunteer eyerolled when you mentioned wanting to start meditating and this left an impression on you.
Apparently, that isn’t something adults I admire do. Done with that; check it off my list of things to try. Like many experiences, this is stored in our brain, referred to, but not something we are fully conscious of i.e. implicit bias.
Start Practicing Mindfulness
Building resilience is possible, it doesn’t take much training, it doesn’t take much time out of your day, research supports the practices and it’s not about being able to sit uncomfortably fighting with your thoughts. Can you see yourself noticing your surroundings more? Just thinking for a moment about your own child before you go in to see a patient who isn’t as fortunate. Being compassionately curious about why your elderly patient comes in to see you weekly when they are really doing quite well.
Can you see yourself being fully aware of how lucky you are as you greet your loved ones after a long day at work? These are mindful practices. They aren’t ‘weird’. Let yourself learn about mindful practices and the research that supports their benefit.
Support your colleagues who are struggling and embrace the opportunity to be more resilient and take part in efforts to improve your work environment. Learn how to build your personal and collective agency!
Amit Sood, MD Resilient Living with Dr. Sood: Building Strength for the Difficult Days. November 27, 2019
Richard G Tedeschi, Jane Shakespeare-Finch (Author), Kanako Taku (Author), Lawrence G. Calhoun in Post Traumatic Growth-Theory, Research and Application, 2018
Adair KC, Rodriguez-Homs L, Sexton JB. How can gratitude help healthcare workers? October 2021.