Why I dislike the word Resilience and prefer Anchoring when talking about physician well-being.
On resilience
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'.
''...but...
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.
Anchoring
''...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.