Pass Me the Psychological Scalpel: Lessons on Resilience for Doctors

Stressed doctor cover face under pressure. Sad nurse, tired physician or upset doc. Medic crying in hospital office. Malpractice, treatment error and mistake or negligence. Workplace bullying.
As rates of physician burnout continue to climb, a diverse group of researchers weigh in on enhancing resilience and particularly emphasize enlightening educators about how resilience develops during residency.

In recent years, there has been increased attention to the growing rates of physician burnout. According to the 2019 Medscape National Physician Burnout, Depression, and Suicide Report, rates of burnout and depression among US doctors did not improve last year1 despite increased efforts by the healthcare industry to address this issue.

The report highlighted that:

● Of more than 15,000 American physicians surveyed, 44% feel burned out

● Female physicians experience burnout more frequently compared with male physicians

● Almost 60% of surveyed doctors reported that bureaucratic demands such as paperwork were the most significant contributor to burnout

● The second most reported reason for burnout was working long hours

● Increased computerization of medical practice (eg, electronic health records) is a significant driver of burnout

There is growing evidence that physician burnout may be associated with major medical errors, as indicated in a 2018 study by researchers at Stanford University School of Medicine in California.2,3 Physician burnout needs to be addressed at both the individual and organizational level, and at the individual level it is essential for doctors to cultivate resilience.

What Is Resilience?

One definition of resilience is the capability to successfully adapt despite experiencing adversity, tragedy, trauma, or significant threat.4 According to Cheryl Travers, PhD, chartered psychologist and senior lecturer in organizational behavior and human resource management at Loughborough University, United Kingdom, “Resilience takes a number of different forms, with the classic definitions talking about bouncing back following adversity. However, it’s also about leaping forward and growing; growth is really important. Resilience is about more than managing adverse moments, but also growing from them.”

Enhancing Personal Resilience

Individual experiences in the field of medicine are diverse. Whether you are currently a resident at a large hospital or on your way to opening a private practice, stressors abound in all branches of medicine. And in the modern healthcare landscape, the pressure only seems to increase every year. Moving forward in your career, you will encounter more challenges and potential sources of stress. It is therefore essential to start cultivating resilience now.

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According to the American Psychological Association, there are numerous ways to start building resilience.5 Some tips and suggestions are to:

Rely on your relationships. Talk to a loved one, friend, trusted peer, or a professional support group. Suffering in silence will only add to the stress.

Maintain a positive view of yourself. Remind yourself that you are capable, even if you do not always feel that way. You are a trained medical professional and have the skills necessary to be effective at work. It is also vital to remember that you can keep learning new skills throughout your career.

Build your confidence. Related to maintaining a positive view of yourself is the concept of self-efficacy, which Dr Travers described as the “belief that you can do things across a number of domains. Goal-setting, in particular, helps build this self-confidence.” When building your confidence, it can help to distinguish between self-efficacy and self-esteem. “Self-esteem is a sense of worth, whereas self-efficacy is a self-confidence in your ability to do things,” explained Dr Travers.

Have interests outside of work. Whether you enjoy cooking, playing a sport, watching movies, or fishing trips, fostering non-work-related interests helps reinvigorate your mind and body when faced with workplace stress.

Keep a healthy perspective. During challenging times, it is easy to blow events out of proportion. Strive to keep a realistic view of situations. It helps to take some time out before responding or making decisions.

Have a flexible and hopeful view of both your career and your life. Personal and professional paths are not always linear. This is not something to fear, however. Fluctuations in your career experiences may even be enriching, providing an opportunity to grow in ways that would not have been possible if your professional path had been more linear. Learn to view any setbacks or detours as opportunities to become an even better physician.

Prioritize self-care. It is important to maintain a healthy eating pattern, exercise regularly, and safeguard your mental health. If you are unwell, it is advisable to take the day off when you can. Presenteeism, or being at work despite an illness, may be more damaging than absence; you may be less alert during your shift, prolong your condition, or even pass your illness on to coworkers and vulnerable patients.

Remember that healing other people is a doctor’s vocation. A qualitative study of 18 obstetrics/gynecology residents by researchers at New York University Langone Health suggested that an individual’s calling to the medical profession is an important factor in resilience.6 Keeping this sense of purpose in mind may help you re-engage with work in the face of pressure.

The Need for Cultural Change and Systemic Interventions

In a 2018 interview with Kaiser Health News, Stanford University Medical Center’s chief of physician wellness, Tait Shanafelt, MD, discussed how the culture of medicine perpetuates the expectation for doctors to be “superhuman” and even show a “lack of vulnerability.”7 Current healthcare systems add to this pressure. Indeed, one survey revealed that physician burnout continues to be a problem despite survey respondents reporting high levels of resilience and emotional well-being.8 In other words, even the resilient are finding it difficult to cope in today’s increasingly demanding healthcare environment.

Changing culture involves shifting perceptions and attitudes in the workplace. According to a recent report by the Society of Occupational Medicine, building a culture that openly acknowledges the profession’s impact on the well-being of doctors and encourages self-care and mental health needs to start as early as medical school.9 The same report also stressed that interventions aimed at helping doctors thrive at work, or treating doctors already struggling, should not be the only focus. Healthcare organizations must assess how working conditions affect the mental health of physicians and make the necessary changes to prevent doctors being unnecessarily burdened by a poor working environment.

Modern demands on healthcare professionals place immense pressure on doctors. Although there are many external stressors outside of a practitioner’s control,  you can take control of developing resilience — and this is one of the most effective ways to ensure the demands of the job do not overwhelm you or prevent you from practicing your vocation.

In the long term, however, it is not enough to expect doctors to simply become more resilient; the healthcare system must show support by addressing the “superhuman” culture that is harming our healers.

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1. Kane L. Medscape national physician burnout, depression & suicide report 2019. Medscape. January 16, 2019. Accessed February 15, 2019.

2. Tawfik D, Profit J, Morgenthaler T, et al. Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors. Mayo Clin Proc. 2018;93(11):1571-1580.

3. Harding A. Physician burnout a key driver of medical errors. Reuters. July 11, 2018. Accessed February 15, 2019.

4. Rakesh G, Pier K, Costales T. A call for action: cultivating resilience in healthcare providers. Am J Psych Resid J. 2017;12(4):3-5.

5. American Psychological Association (APA). The road to resilience. APA website. Accessed February 15, 2019.

6. Winkel AF, Honart AW, Robinson A, et al. Thriving in scrubs: a qualitative study of resident resilience. Reprod Health. 2018;15(53).

7. Ostrov BF. Stanford’s chief wellness officer aims to prevent physician burnout. Kaiser Health News. August 3, 2018. Accessed February 15, 2019.

8. Canadian Medical Association (CMA). CMA national physician health survey. Ottawa, Ontario, Canada: CMA; 2018. Accessed February 15, 2019.

9. Kinman G, Teoh, K. What could make a difference to the mental health of UK doctors? A review of the research evidence. London, England, United Kingdom: Society of Occupational Medicine; 2018. Accessed February 15, 2019.

This article originally appeared on Medical Bag