Resilient Doctors are Connected Doctors
Helping Hand Column, May, 2010
In my training as a child psychiatrist, I recall reading with great interest about Donald Winnicott’s conceptualization of the psychic space between the mother and child, which he termed the Holding Environment. If this were properly created and provided by the mother, it allowed for the child to feel ‘held’ – taken care of, safe, protected, understood, loved. This formed the basis for the child to learn to trust and grow, and transition to becoming more autonomous. In fact, I realize that we need nourishing ‘holding environments’ throughout our life, so we can continue to feel safe and grow. As we get older, these holding environments build resiliency, and can be found within the context of our school, sports teams, friendships, relationships, and in our workplace. The key aspect of the holding environment is the presence of people who make us feel held.
The single most powerful predictor of resilience is the presence of caring connections with others. We need to create these relationships, and then reach out to them regularly for help, support, guidance, and encouragement.
The culture of medicine makes this crucial aspect of connecting difficult to attain. In our training, we are taught to be tough and strong, and to manage on our own. If our past experiences in life have taught us that there is little help available and we can only count on ourselves, we survive well in medicine where this is the norm. We have full practices and busy days, focus on providing our best care, and often do not have time to stop and socialize with colleagues. Even if we did have time, many hospitals have now done away with the traditional doctors’ lounge, a place where much of the conversations and connections would have been created and maintained.
Kjeldstadii, Tyssen and their colleagues published a study (BMC Medical education, 2006) looking at life satisfaction and resilience in Norwegian medical schools, and concluded that medical schools should encourage students to maintain their outside interests, friends, and personal lives. Jensen, Trollope-Kumar and associates in Hamilton, Canada, explored dimensions of family physician resilience (Can Fam Physician, 2008 May), and highlighted the value of supportive relations, which include positive personal relationships, professional relationships, and good communication. Lemaire and Wallace (On Physician Wellbeing: You’ll get by with a little help from your friends, 2005) showed that support from spouse and coworkers as well as positive patient interactions is a key factor to reduce stress and increase wellbeing.
In our professional life, we must look for opportunities to build positive relationships – with our colleagues, medical team, staff, and patients. Doctors tell me that one of the biggest stresses at work is working with other doctors who are stressed. Take time to get to know your colleagues, find out a bit about them as people, ask about people, things and events that are important to them. Attend and join in social activities in the workplace. Be positive and appreciative to others; look for good things daily and comment on them. Enjoy the opportunities and privilege our patients offer by allowing us into their lives at pivotal times. Look for and be a mentor. Create a culture of collaboration and collegiality, learn to communicate effectively and resolve conflict in a healthy manner. Make time to sit down with peers, talk about difficult cases, offer support. Many doctors speak of the value of their journal club, small learning groups, or Balint groups. I can personally attest to how my journal club has bolstered my ability to be resilient. Our group (we call ourselves the PALS – Psychiatrists At Large!) has been meeting monthly for about 20 years. They are the perfect holding environment – they are reliably present, make me feel liked and respected, and so allow me to ask questions and advice without fear of being seen as weak/stupid/failing. While we have greatly contributed to ensuring we are all medically up to date, we have also seen, supported, and celebrated each other as we go through life and all that it has to offer.
In our personal life, all of us require a personal support system of partner, family, friends, and social and spiritual community. A supportive home environment allows us to recharge at the end of a busy day, and creates energy so we can go back and do it again the next day. Such an environment must be constantly nurtured. We need to allocate meaningful time for this, make and keep regular dates with our significant others, family, and friends. We have to be available and present when we are not at work, to participate actively in life at home. Regular communication is essential with the people we care about. Some people find that being active in community, civic, or faith-based organizations provide social support.
The primary factor in resilience is having caring and supportive relationships in all parts of our life. Relationships that create love and trust, provide positive role models, and offer encouragement and reassurance provide a buffer against adversity and help us to build resilience. There is strength in numbers; the people around us make us strong. Make sure you create such relationships and reach out and use them!
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 firstname.lastname@example.org. 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.