You don’t necessarily realise you need resilience until you start suffering the consequences of not having it
Resilience. It’s a word you hear almost everywhere these days don’t you?
Whether it be a quality you try to instil in your toddler, or a necessary character trait to survive the challenges of old age, it would seem everyone is of the opinion that it is a fundamental necessity to manage life.
In general I tend to shy away from the latest psychological catch-phrases that creep into management vernacular. I don’t want to “reach out” to anyone, nor be “on the same page” or “moving forward on a journey”.
But resilience is different. Especially in our profession and in our specialty.
It is a well-known fact, from research here, the US and the UK, that doctors have disproportionately high rates of stress and mental illness. And Australian general practitioners experience high rates of depression and burnout, a condition recently recognised by WHO.
Much has been written as to why we are so vulnerable to this particular adverse professional outcome, but it’s not really rocket science is it?
Our days in clinical practice generally involve a series of intensely personal connections, balancing an array of uncertainties, dealing with the full range of the human condition and assuming the responsibility of optimising an individual’s experience with the world of medicine and the health system – all in 15-minute increments.
And that’s just the start. Add the frustrations of bureaucracy, the pressure of time constraints, the spectre of litigation and the indiscriminate nature of whom gets what illness, it’s pretty amazing we’re not all curled up in a corner asking for Scotch and Valium.
You could argue that perhaps all those UMATs, GAMSATs, interviews and assessments could help differentiate only the more resilient candidates to do medicine in the first place. Surely, with all the advances in personality analyses and character profiling, the powers that be could identify those people who are most vulnerable to becoming emotionally overwhelmed by the demands of the job.
Apparently not. Just taking the UMAT as an example, that particular exam tests suitability for medicine based on three main areas – logical reasoning and problem solving, understanding people and non-verbal reasoning. Not a single mention of the R-word.
Of course, that is reasonable. How would you determine resilience in a medical candidate? What character traits would you look for that might ensure they won’t suffer burnout? Ability to detach oneself from another person’s emotion? Failure to feel regret, uncertainty, responsibility or stress? Sounds more psychopathic than emotionally robust!
Let’s face it. The risk is inherent in the nature of the work we do, rather than the people who do it. To do our job, or at least to do it well, especially as GPs, we have to engage, empathise, and invest emotionally.
And hence the groundswell of opinions, information and advice on how we can build resilience among Australian general practitioners.
There are many experts out there.
In general, their advice focusses on three main areas: self-care, monitor for warning signs and seek help early. It all sounds very logical and simple, but of course we’re talking about a cohort of professionals more comfortable giving advice than receiving it.
Nonetheless, I do believe the situation is improving.
For a start, the problem is now increasingly recognised as a professional risk rather than a personal failing.
Once it becomes accepted that we are all vulnerable, we can look to those people who do exhibit resilience and learn from their example. GPs who have not only survived but thrived for many years without experiencing burnout.
We can learn from their experience, just as we can learn from those patients of ours that manage to remain positive and keep going despite one setback after the other.
In my case, I can think of many admirable GPs who have enjoyed clinical practice for decades and consider their work with more of a sense of satisfaction than exasperation. Common features among them is physical health and fitness, frequent holidays (not necessarily big holidays but “getaway” time – something to look forward to) and a passion outside medicine – be it cycling, the church or farming.
Interestingly, they all continue to invest heavily in medical education. I’m not sure if this is a coincidence, but it could point to building resilience against the uncertainty of general practice and the fear of misdiagnosis which is a consistent stress.
And then there are the lessons in resilience we can learn from our patients. I’m sure you, like me, look after people that seem to have been born under an unlucky star, or who are under the most enormous stress, and yet continue to smile and find joy in life.
One in particular has taught me so much in terms of attitude and outlook. Her secret – surround yourself with positive, supportive people and talk to them – frequently. The need for GPs to “debrief” after traumatising experiences in clinical practice is now generally accepted across the specialty.
No one needs to process these challenges alone. In addition to friends and colleagues, closed, safe forums such as the Facebook group, GPDU, have been immeasurably beneficial in this regard.
Resilience is tricky. You don’t necessarily realise you need it until you start suffering the consequences of not having it. We need to start considering building resilience in the same way we think of diet and exercise – an investment in our future health.
Our longevity in the profession may depend upon it.
