Resilient physicians deserve resilient medical systems

Medical Post
Helping Hand Column, November, 2010

Attempting to define the dimensions of resilience in physicians in past columns has been an enriching experience.  Instead of answers, my questions often led to more questions.  The five components that I have defined are a good start, informed by years of clinical experience.  Yet, it is clear that this area is one that requires much more thought and research in the future.

There will always be stress in the practice of medicine.  Much of this is positive, healthy and motivating.  The desirable goal in assisting physicians to become more resilient is to have them build skills and energy reserves so they can continue to cope well in times of stress.  Young’s modulus, from engineering’s solid mechanics, refers to the measure of the stiffness of an isotropic elastic material.  It refers to the ratio of stress, with units of pressure, to strain.  In medicine, while we are hoping to reduce the strain, we have no real ‘units of pressure’ to measure the stress.  As well, the stress comes from multiple sources, and varies depending on the physician, their specialty, demographics; thus it requires multiple resources to manage.  

Addressing the five components of resilience in an individual physician is like laminating a piece of paper.  It gives it an extra coat, makes it hardier, and more flexible.  It will allow the physician to feel more empowered and confident to handle unforeseen and unpredictable events, and so can enhance the system.  Yet, it is not enough.

I recently had a thought-provoking discussion with a colleague in the Department of Epidemiology on the value of improving resilience among colleagues.  Is this a good thing?  Or can this be exploitative? The concern, of course, is that as the situation in medicine continues to worsen with fewer resources and more stressors, we merely respond by helping doctors just cope better and do more with less.  Doctors are known to be responsible, conscientious, and people-pleasing; and are not good at demonstrating ‘visible pain’.  When things are tough, and there is more to do, we just buckle down and do more.  The end result is that we take on the pain, yet it is not visible to others who just assume that everything is fine.  The irony is that unless others see the pain, there is nothing for them to respond to and improve to lessen the pain.  Thus, the system does not improve.  What we are striving for is a balance, one in which physicians feel more empowered to cope in difficult situations, and also have a voice and sense of control to make their pain visible, to constructively identify the problems that need to be addressed and resolved.

It is clear that making physicians more resilient cannot occur in isolation.  The relationship between physician and systemic resilience is complex, and bi-directional.  While we can assist the individual physician to proactively manage in a healthier manner, we need system level interventions too.  The goal is not to train our physicians to merely become more plastic peons in the medical system.  Resilient physicians require and deserve a more resilient medical system in which to work.

 

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.