Why I dislike the word Resilience and prefer Anchoring when talking about physician well-being.
Let me tell you a little secret...I hate the word resilience. Actually, that's not quite right. What I mean to say is, I've come to hate the word resilience. You heard that right. Hate it.
My relationship with 'that' word started about 5 years ago. It seemed to be the word of choice to describe...you know what. A bit like the word 'unprecedented' during the pandemic. Several years on, I can safely say I've developed a mild form of PTSD triggered by that word. It makes me nauseous. I know I definitely can't attend any seminars on resilience. I usually break out in a light sweat and I have to walk out.
I bet you're wondering why?
I recently started reading a book (now abandoned as too close to the bone) called Also Human: the inner lives of doctors. In it, I found this quote, which I'll use to explain why resilience doesn't work me.
''...The patients we work with have fallen through the ice in the middle of a frozen lake...My job - the doctor's job, should you choose it - is to go out to them, to be with on the thin ice, and to work with them to get them out of frigid water...''
Anyone capable of stepping on to that thin ice to begin with despite their personal circumstances, history, traumas, life events, grief and journeys... This person IS RESILIENT. Especially if one's life encompasses all of the above personal circumstances and more. The idea of making this person more resilient is a bit presumptuous. This is what I refer to as 'ridiculous dressed in a dollop of pseudo-compassion'.
When this person is asked to become more resilient, it’s akin to saying to them that they need learn how to be better at standing and walking on thin ice. If it cracks under your feet and you go down, well you learn from that...be more resilient. It places an unhealthy proportion of responsibility, and creates a vacuum for blame and shame to thrive.
In healthcare thin ice represents finite resources, poorly funded and inadequately staffed healthcare systems. These are the circumstances most healthcare professionals (not just doctors) will step into. It also does not take into account the personal and collective cumulative fatigue, emotional exhaustion, moral injury and decision fatigue. So when I'm sat in yet another seminar or conference about 'how to be more resilient' in healthcare, I find myself deeply frustrated. The conversation needs to change perhaps to a focus on 'how we keep ourselves safe 'on the thin ice'.
you should know that if you go out...on to the thin ice... there is a real danger that you'll fall in too...''
The sad truth is ... there are a number of doctors who succumb as a result of the job. I can personally think of a handful of doctors I've worked with throughout my career who've either died or nearly died as a consequence of the job through suicide. The number is not insignificant.
From my perspective, every single doctor that has 'stepped out on to the ice' or chosen this profession is resilient. Many of us will step up and feel the thin ice groan beneath our feet. We take time, we check our footing and keep moving forward towards our patients (and sometimes loved ones). Many are exhausted, depressed and anxious. Naturally, most are transformed by the experience. Majority make it back to shore and bravely step out again. They do it over and over until they retire.
Sadly, there are some who feel the ice groan, then crack...sometimes it's a slow process, giving people just enough time to try grab hold of them and pull them to shore. For others, it's so fast, no one sees it coming. They're gone almost in the blink of an eye. Just missing. It is not because they're 'not resilient'. If anything, maybe... just maybe...they may have been 'too resilient'.
So, if resilience doesn't work for me then what does? I prefer Anchoring. It seems to me to be a more holistic and compassionate approach to physician well-being.
''...So, if you go into this work, you've got to be anchored to the shore. You can reach out with one hand to the person in freezing water...BUT... the other hand needs to have a firm grip on the people and the things that connect you to the shore. If you don't, you'll lose both your patient and yourself...''
This quote has stayed with me. It resonates deeply with my personal journey as a doctor.
Each person courageous enough to take on the practice of medicine, to witness the joys and sorrows, ill-health, death, cradle to grave, IS resilient. It is a risky business to stand on 'thin ice'.
Truly worthwhile but risky because lives are involved.
The more one does it, the higher the risk or some form of harm. So, how does one stay safe in this environment? One anchors oneself. 'A firm grip on the people and things that connect you to the shore'.
Anchoring to the shore
I prefer the word anchoring to shore. It is not easy to do this job without being anchored to something or someone that provides strength and support. The Anchor may be people, things, friends, mentors, colleagues, neighbours, hobbies, nature, pets, home, Faith, community. The list is as endless.
The Anchors not only provide strength but they also help replenish and heal the mind, body, spirit and soul. This in turn enables the Anchored person, in this case the physician, to continue with their vocation of stepping on to the ice. It also helps feed the Joy, Hope, Faith, Light and dare I add, humour to those vast spaces of suffering and ill-health.
(Re)Discovering the things that anchor me
The conversation from resilience to anchoring for me, occurred sometime in 2020. We were in throes, of the pandemic at that stage. Then one fine day, the proverbial thin ice, gave way under my feet, while I was out doing the job. The anchors, which I had been so sure of and had neglected to check and look after...suddenly was not strong enough to hold. I had to retreat to the shore line, to find my footing, to heal and re-build. This is what I discovered about my anchor and what it consisted of.
Family. It wasn't just about spending time with them, it was knowing that they were in good health. Both my parents are older and my mum is a nurse (who happily worked throughout pandemic patient-facing despite having retired in the previous year). Lockdown meant that like many people I didn't see them for over a year.
Friendship. I discovered a handful of my friendships were restorative when I needed anchoring. So, I let them know and leaned on them (when they had they emotional bandwidth). *Sometimes a friend is only able to anchor for a season or maybe not all. Perhaps, they need anchoring. This IS ok. There value as friends does not diminish. I too am an anchor for others. We all form a network of anchors….anchoring each other, anchoring our neighbours, strangers as well as friends. This is life.
Mentors. Well I have a handful and trying to poach one or two more. Hahaha. One of these is the epitome of the word Anchor. They are anchor I often run to when I need safe ground.
Colleagues. I have a group of women who've become a sisterhood of sorts. They're on the ice with me and we look out for each other. If any of us has a wobble we all reach out to steady and strengthen.
Silence. The irony of ironies. Those who know me personally, know I'm complete chatterbox, a bit opinionated in certain things and have a clever/funny retort for many things. Yet, when it comes to anchoring, resting, replenishing, it is in silence that I found this. Silence and quiet rest periods. Go figure. So.... I went on long walks in nature alone, picked up acrylic painting and crocheting.
Good nutrition, hydration and sleep. I know...as old as the gospel this one. But sometimes I forget and often needed to be reminded.
Well-being and health. My GP, dentist, therapist. The triad of well-being MOT.
Faith. Especially in my periods silence. Actively nurtured. I needed it.
Some of the things on my list are universal and others are unique to me. The trick I think, is to figure out what the unique combination is for each person. Each person needs to encouraged and supported to go on this journey. Perhaps the appraisal could include this aspect because this is a compassionate and holistic way of staying safe and healthy in healthcare.
***It is worth mentioning that not everyone will understand or agree with the concept of the Anchoring. Some people in my life really wanted to be a part of the anchor. I realised they took from me what I was incapable or unable to give because of the demands of the profession. I had to learn to be brave enough to step away from this energy with kindness and compassion. This too was okay...is okay.
Lean onto the anchor frequently
'...Remember walking on thin ice to rescue our patients...' Learn to lean on to the anchor regularly. Otherwise, the job can become overwhelming with sorrow, fatigue and with an increased risk to one's well being. Personally, I lean onto my anchor daily in small doses. Every 6-8 weeks, I take some time out replenish and to check that my anchor will hold.
Leaning onto that anchor frequently, also means we absorb the light, hope, compassion and joy. This we then transmit to our patients and the people around us especially when they most need it.
Reading. Excerpt from - Also human: the inner lives of doctors. By Carol Elton