Dirty or not, maybe the real problem is the word itself.
There has been some recent heated debate about encouraging and supporting resilience in healthcare staff – specifically for doctors in training.
As a starter here are 5 statements on which I am (reasonably) confident we can all agree:
Working in medicine can be physically and emotionally demanding
Staff health and wellbeing are of the utmost importance
We should work in supportive environments and feel safe, well and valued
All staff have bad days and we all need a helping hand from time to time
A system that is not coping is no excuse to ask staff to ‘suck it up’ and cope
So what’s the problem? The debate about resilience is not new. The argument, familiar to many, goes like this: encouraging doctors and medical staff to ‘be more resilient’ is just a crafty way of diverting attention from understaffed rotas and deteriorating working conditions in an effort to get individuals to be more accepting of clinical environments and staff stretched to breaking point. In a great piece from David Oliver in the BMJ (1) he captures the essence of this view beautifully:
“Absorbing” any unacceptably and avoidably “negative conditions” makes resilience a dirty word. It shifts the blame and responsibility for doctors’ struggles away from what are often over-politicised, understaffed, underfunded, badly organised systems and onto individuals.”
In his article Oliver argues eloquently that what is required are more resilient systems not individuals. I am in near-total agreement, especially with the notion that we need to encourage staff to innovate, change and improve elements that are not working or causing stress, not simply to accept them and do our best to ‘get up off the mat’ time and time again.
However I was also struck by an article written by Dr Alys Cole-King (2) in response to a previous flurry of discussion on the topic, which prompted a GMC response entitled “Doctors under pressure need resilience, not mental toughness.” It is worth a read. In it she says:
“Emotional resilience is about adaptive coping skills, understanding and managing one’s emotions and seeking social support to enable the ability to ‘bounce back’ or even experience post-adversity growth following a stressful event. It is not only the ability to cope with stress but being able to thrive and flourish even in difficult circumstances. It is not about asking doctors to ‘grin and bear it’ and to handle intolerable organizational pressures or excessive workloads. Neither is it about the naming and shaming of ‘weak’ doctors for not being tough enough to cope with the pressures placed on them. Quite the opposite, in fact.”
The key point here is that even if we were to conceive a system that could respond perfectly to the needs of doctors and other staff, where rota gaps were a thing of the past and education, supervision, training and support were perfectly pitched, we would still have a problem in medicine. Regardless of how well adapted the system is in which we are working, all of us will experience loss, grief, frustration and stress in our working (and personal) lives. This is, of course, both a simple truth and a function of the fact that we are ‘Also Human’, to quote the title of Caroline Elton’s wonderful book (3). For many staff a ‘normal’ day at work might involve experiencing the death of a child, working in a high-pressure environment, experiencing conflict with colleagues, performing high-risk surgery or telling people that they have incurable cancer. To say nothing of the concurrent challenges we will all face outside of work, be they family or relationship problems or our own ill-health.
The system can and should be designed to support the individuals working in them and we need to continue working hard to achieve this. But all of us need support and help in developing our own personal strategies and mechanisms for experiencing the adversity that naturally presents itself in this, our most rewarding, wonderful, privileged but at times highly challenging profession. Of particular importance, we also need to help our colleagues and juniors to do this. Call it resilience if you like, or call it nothing, but it matters. We should be careful not to throw the baby out with the bathwater because of the word.
1. When “resilience” becomes a dirty word. David Oliver
2. Doctors under pressure need resilience, not mental toughness. Dr Alys Cole-King
3. Also Human, Caroline Elton, 2018