Resilient doctors are Confident doctors

Medical Post
Helping Hand Column, March, 2010

Resilience is the ability to deal with difficult events, be flexible and bounce back, and grow as a result.  It is a dynamic concept, an ongoing process which can vary over time.  It has many dimensions, including a sense of confidence and control which will be the focus of this column.

Confident people are those who have a positive view of themselves, their strengths and their abilities, and are known to cope better during stressful situations.  Developing such confidence and nurturing a positive view of one self is possible, and helps build resilience.

Where does this self image come from?  Our sense of self is the product of learning, built though our life experiences since early childhood.  The greatest contribution comes during our formative years, from parents and caregivers who serve as mirrors and reflect back to us an image of ourselves.  Experiences with other family members, teachers, and friends add to the information we use to create our self image.  It is reinforced by messages from the media, as well as ongoing relationships and experiences. These are integrated to create an inner sense of our strengths, weaknesses, physical appearance, values, and adequacy.  This is what I call the Historian, a teller of our personal history. If it is positive, we can appreciate our assets and potential, and be realistic about our limitations. It can help us see accept change, focus on what we can control, and conceptualize challenges as opportunities to learn and grow.  Yet, if negative, we focus on our faults and distort imperfections, and minimize or even dismiss abilities and achievements.  This influences how we think about ourselves, which in turn, influences our behaviour and how we react to stressful events. 

Many doctors have had childhood experiences they have perceived as providing negative feedback, which has led to their History of a sense of personal inadequacy, of not measuring up.  This is an unconscious conclusion, and while we are not aware of it, it impacts our behaviour.  It is part of the reason for our success to date – it leads us to try harder, do better, and achieve more.  Yet, the Historian often continues to perpetuate the feelings of inadequacy. We are not always able to feel confident in our abilities and achievements, and may have a persistent sense of self doubt. We feel like an imposter, even though there is no basis to this. While we can appreciate this when our friends and colleagues do it, and tell them it is not true, we cannot see how we do it ourselves.  Try the “Best Friend” technique – when feeling negative about yourself, think of your best friend feeling down on themselves for no reason, and what you may say to them.  Then, say the same to yourself.

I believe that we are all born with a positive sense of self, and imagine it to be like a shiny bright jewel.  Just look at children in healthy environments, innocently taking pride in what they do and celebrating simple accomplishments.  I recall one of my sons at age 2, climbing up onto the piano bench, randomly striking piano keys, then clapping his hands and taking a bow.  His positive sense of self was apparent, glowing like a gem.  If I were to reply “Good job”, the jewel would continue to glow.  Yet, had I told him to “quit making that noise’, or to “climb down from that bench before he fell off”, I would have put a layer of covering over that gem and it would shine a little less brightly.  Repeated negative incidents put more layers on the jewel, so that it becomes less visible and, then, forgotten.  Over time, we may become self-critical, adding layers ourselves when no one else is doing so.

Luckily, we can learn to rewrite our history so it is more accurate and less distorted.  Cognitive therapy can assist with this.  We learn to recognize how we distort our thinking, challenge our negative self-attitudes and self-perceptions, and balance them with positive self affirmation.  Effectively, we catch ourselves as we start to add a layer of covering and stop.  We can even learn to unwrap previous layers, and slowly, start to see the jewel shining through again.

While self confidence is an attitude that we can develop, this takes time; there is no quick fix. There are two aspects of this -self esteem, and self-efficacy- both of which must be reinforced.  Self esteem is the sense that we have strengths and can cope with what is going on in our life. Self efficacy is our competence, our ability to learn knowledge, master skills, so we can accept challenges, persist and succeed.  With the right combination of attitude and knowledge, in a time of stress or crisis, the confident person is optimistic and has the sense and belief that they can do it.  As a colleague recently told me during an exceptionally stressful time, “While I don’t want to be going through this, I don’t question that I can.”

A positive self worth fosters personal growth through adversity. There is freedom from doubt, leaving no question that, in any situation, we will handle what is presented, and succeed.

 

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.