A Resilient Doctor is a Calm Doctor

Medical Post
Helping Hand Column, September, 2010

We all know them – the doctors who can be in the midst of turbulence and chaos, and manage to stay calm. These are the colleagues at work whom we admire, since their day seems to take less out of them.  We wonder how they do it, as we become increasingly frustrated and reactive.  As physicians working in highly complex situations, challenges seem to occur daily; and it is normal to have resultant thoughts, feelings, and emotions.  Yet, the behaviour that can result form such negative emotions is unhealthy for us, and often unacceptable for others.

There are basically two factors in being calm:

  1. learning how to recognize triggers and when things are starting to build up
  2. developing successful strategies for managing the associated emotions

During a quiet moment, take time to reflect what the triggers are, both at home and at work.  There is usually something or someone that pushes our buttons.  Think about this, and try to understand the inherent patterns.  In a previous column on resilience, we spoke about my 90:10 Rule, that only 10% of our reaction in any situation comes from that specific situation, 90% is from past experiences.  Try to acknowledge this, and dial down the intensity of reaction to a tenth of what you feel at that moment.  This allows you to stay calmer, and use one or more of the techniques below to maintain your sense of calm and control, and cope more easily.

None of us does it perfectly.  It helps to have a range of tools to rely on as needed.  Just as we want to have a spectrum of antibiotics to use, choosing depending on factors such as the site and organism causing the infection; when we know of a range of techniques to calm ourselves, we can more easily choose and access the best one for that situation.

Take a deep breath.  This is a good first choice, as it is easy to remember, takes little time, gives you a chance to stop and not just react, allows you to focus on something else for a moment, and provides extra oxygen to your brain while you are thinking of how to respond.

Count to ten.  This is easy, distracting, and again, it buys you a bit of time before you start to react to the situation.

Reframing.  How we think impacts how we feel; this is the basic underlying premise of cognitive therapy.  A good example is the concept of Recalculating. As our car’s GPS tell us when we take a wrong turn or go off course unexpectedly, it is “recalculating’ and comes up with a new plan of action.  Yet, it does so in a calm, unemotional, non-judgmental manner. In our home, we have taken on this phrase to remind and encourage each other to ‘recalculate’ similarly when things go off course unexpectedly. 

Positivity. Research shows a clear link between positive emotions and a happy, healthy, and productive life. Consciously look for the good in the world around you, make a positive contribution yourself, express appreciation, be optimistic.

Relaxation Exercises. There are so many different exercises to help us relax after our bodies deal with tension. These work to break down the tension, relax the muscles, and promote an overall relaxed physical and emotional state. They create a relaxation response, a state of deep rest. Relaxation techniques can include active or passive progressive muscular relaxation, visualization, and yoga.  Find music or a CD/DVD that can guide you properly through such an exercise.

Mindfulness Meditation.  Meditation helps to increase our awareness of our reactions and help to develop healthier ways to cope.  By staying in the present moment, and facing problems, we can reflect, gain a new perspective, and manage and act differently. We focus on observing our breath, thoughts, feelings and sensation; experience what is actually happening instead of ruminating or trying to change things.  We often see more possibilities, instead of reacting in our usual patterns of behaviour.

Nurture spirituality. Spirituality is defined as the deepest values and meanings by which one lives. Spiritual practices focus on developing our inner life, thereby allowing us to feel more connected with, and have faith in, the world around us. Having faith has been shown to give one strength and comfort. Spirituality is not the same as religion; religion can be one form of spirituality.

Journaling. Taking time to put feeling into words helps clarify things and highlight options not previously seen.   When writing, we can have an outlet and let go of feelings that we cannot or should not share with others. Writing about a difficult day at work, or a tragic patient outcome, allows us to validate and manage our feelings in a safe, private and effective manner.

Any of the above techniques can be effective in assisting us to feel a sense of calm at home and at work, but we have to practice.  It is a process of learning and teaching our body what a calm state feels like and how to attain it.  The more we do it, the easier it becomes. When practiced regularly, these activities will lead to a reduction in daily stress levels and an increase in sense of joy and calmness.  They serve as protective armour in the face of life’s challenges, and give us the strength and energy to remain resilient.

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.