A Resilient Doctor is a Committed Doctor

Medical Post
Helping Hand Column, July, 2010

As doctors, we choose to enter the medical profession because we want to make a difference.  We can easily recall that dream we had as a medical student – of wanting to cure illness, stamp out disease, and make our patients better.  Many of us affirmed this as we took the Hippocratic Oath, promising to uphold professional ethical standards as we treat patients with spirit, diligence and dedication.

Having a continued sense of commitment to this cause allows us to face each day and persevere, especially at times when it is not always easy to do so.  This commitment to what we value and respect is key to our ability to be resilient.  As long as we can feel that we are living fully and working towards meaningful goals, we are able to manage with whatever is thrown our way.

In medicine, we must ask ourselves and constantly remember “What drew us to this?” As we start working, it is easy to become too busy and lose sight of what was initially meaningful to us. Medicine is both a calling and a career.  Over the 40 years that the average physician works, we can go through many normal and natural phases of our career.  In the early phase, we are still full of energy and excitement and anticipation, and have a lot of drive.  This gives way to the middle phase, when the reality sets in, and we are not able to do all that we want to, and have to reframe our goals to fit our current reality.  It is here that we may question our commitment to medicine, and so need to remain focused.  The later phase follows, in which we define and reconcile our priorities, restate our commitments and forge ahead. One of my psychiatry professors wisely told me that we can only do what we are doing well for about 7 years at a time; then we should reassess and modify it to continue to enjoy it.  We must actively shape our career paths in medicine so we can continue to feel committed to work that we enjoy.  While this is not easy, bringing up initial fears, guilt and uncertainties, it almost always results positively in a renewed sense of commitment.

Journaling is a way of telling and recalling our story.  In her book, Kitchen Table Wisdom: Stories that heal, Rachel Naomi Remen invites us to ‘listen from the soul’.  Her concept of Kitchen Table Wisdom is that of the human tradition of shared experiences and stories told around the kitchen table, which demonstrate life with all its power and mystery, and remind us that the things we may not be able to measure may just be what ultimately enrich and sustain our lives. Try it yourself! Sit with a blank piece of paper, and reflect. Ask yourself what made you decide to become a doctor, what now gives you meaning as a doctor, what story stands out in your memory as the best thing you have ever done as a doctor.  These stories will serve to accomplish what Dr. Remen’s encourages us to do - to ‘recapture the soul in medicine”.

While a vital commitment to our work is essential, this is even better extended to all aspects of our life.  Ideally, we commit to life, to living fully and aiming for meaningful personal and professional goals.  

Victor Frankl describes his experiences in the concentration camps in his book, Man’s Search For Meaning, and explains how his sense of commitment to values and goals enabled him to survive such an experience.  He created logotherapy, a form of psychotherapy which considers man as a “being whose main concern consists in fulfilling a meaning and in actualizing values, rather than in the mere gratification and satisfaction of drives and instincts…What man actually needs is not a tensionless state but rather the striving and struggling for some goal worthy of him. What he needs is not the discharge of tension at any cost, but the call of a potential meaning waiting to be fulfilled by him."

To be at our most resilient, we can identify the aspects that we value in all parts of our life – at work, relationships, family, home, friends, and for our self - and decide what we are going to do to maintain these priorities.  Think of the story of the Big Rocks and the Little Rocks. A professor shows the class a pile of big rocks, small rocks, sand, and some water, and asks them how to put them all into a big bowl.  If the water or sand go in first, there is not enough room for the rocks.  Yet, if the big rocks go in first, the small rocks will all fit in around the bigger ones, and the sand will fill in among the rocks, and there is even room for the water in the bowl.  The message is that the order of which we do things is crucial – that we place the big rocks in first.  Identify what your Big Rocks (priorities) are, and place them in your day (bowl) first. 

As we set, reassess, and reset personal and professional plans and goals, we can ensure they are realistic and meaningful, and will continue to provide us a sense of fulfillment and purpose.  Once the things we do in our life make sense, we can more easily cope with the challenges along the way, and sustain the sense of wisdom, wonder and richness of life. 

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.