How resilient are you?

Medical Post
Helping Hand Column, January, 2010

I have worked with physicians in distress for years.  Interventions with physicians have been based primarily on pathology: identifying, responding to, and solving problems. More recently, I started to look at physician health from a different perspective, and ask “Why do some physicians cope better than others in the same situation?”  Some of them seemed to have more resilience.  Yet that led to more questions.  What is resilience?  What are the qualities of a resilient physician?  What was it about them – is it a way of thinking?  A way of doing? Was it something they just had in them?  Could it be taught?  This new focus on resilience is proactive, positive, and offers primary prevention.  It helps to recognize strengths and skills, and offers an opportunity to develop strategies for success that build on existing capabilities.

Resilience is a word often used, yet it can mean different things to different people.  The more I researched this, the more I recognized that we do not really have a full definition of this concept.  There is not much written on this topic, and each author has a distinct view.  Perhaps all the various definitions are part of the complete picture, and resilience has many dimensions.  My goal is to clarify and define this further.

The American Psychological Association, post-9/11, defined resilience as “the ability to adapt well in the face of adversity, trauma, tragedy, threats, and from sources of stress such as work pressures, health, family, or relationship problems.

In my practice, I have seen how having resilience allows people to bounce back, and rebound from major life setbacks even stronger than before.  Healthy people with a lot of resilience have personalities that seem resistant to stress, and can learn valuable lessons from difficult experiences.  They are confident and optimistic.  In tough situations, while they may feel understandably distressed, they assume that things will work out well in some way.  They have a reaction that is focused on coping and learning, rather than being a victim and blaming.

As physicians, there are so many stressors we are dealing with on a daily basis in all parts of our lives.  Some of them are inherent to our work, as we take care of others and intimately witness fellow humans suffer and meet life’s challenges. 
We also have to deal with changes and transitions in our own life.  Medical training brings with it the stressors at each phase – medical school, starting clinical work, graduation, residency training, early career issues as we set up practice, likely consider later career adjustments and changes, and then plan for retirement.  There are associated financial stressors.  There are physical moves, to new hospitals, neighbourhoods, cities, and even countries. We all experience ongoing changes with our personal physical and mental health, and may have to learn to live with serious and chronic illnesses. There can be personal transitions, including dating, marriage, separation, and divorce.  We may have children, and deal with the various challenges at each phase of their lives, and then deal with the empty nest as they grow up and move away.  Some of us deal with issues of infertility, and consider options of treatment and adoption, or adjusting to a life without children.  Life brings loss, and we deal with the serious illness and death of loved ones – parents, partners, friends, colleagues, and children.  In other countries of the world, physicians deal with all of this, as well as managing the devastating results of hunger, poverty, or war.

Resilience is the ultimate life skill.

According to the Harvard Business Review, 2002, "...more than education, more than experience, more than training, an individual’s level of resilience will determine who succeeds and who fails."

I believe that resilience can be taught so we can better succeed.  There are some non-modifiable factors, such as our genetics, parents, upbringing, and childhood experiences that play a role in our current abilities to cope through difficult situations.  Yet, there are many modifiable factors too.  We can learn to modify our perceptions of our self and the situation, recognize learned behaviors and assumptions that do not help us, attain a positive attitude, become more self assertive and set limits and boundaries, and be more confident in reaching our and connecting with others.

I am working to identify several dimensions of resilience that can lead to specific tools for cultivating resilience.  I will address each of these in future columns…stay tuned.  In the meantime, I welcome your personal thoughts, suggestions, and anecdotes on resilience.  

Mamta Gautam is an Ottawa psychiatrist who specializes in treating physician patients. If you have a question you would like addressed in this column, please contact Dr. Gautam at mgautam@rogers.com. Please include “Helping Hand” in the subject line. All inquiries will be confidential. Your questions will not be replied to, but may be selected to be answered in this column, which is intended to be educational, not therapeutic.