The Case for Personal Resilience Strategies in Changing the Focus from Burnout to Wellbeing

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By: Amy Locke, MD, FAAFP

Physician well-being is a major focus of many physician organizations and is frequently highlighted in popular media.  Some have described the root of the problem as a disconnect between expectation and reality.  This is a helpful framework for situations that result in disappointment.  I recently rented a house on Airbnb. Eagerly anticipating our vacation, I was dismayed to find upon arrival that the house lacked electricity and water.  Camping in a cabin is potentially much more fun than a cold wet tent, and we ended up with a good trip, but we arrived without the necessary tools to succeed and our expectations were definitely not met.  In this scenario, either changing the expectations or changing the reality could have reduced our distress.  However, in Medicine, many feel that the reality is the bigger problem.

As we look to tackle the reality, there are techniques that can help physicians with tools to manage more effectively.  They also have the potential to help manage expectations.  Self-care and self-awareness are techniques that help physicians optimally function.  Some view a focus on self-care as a distraction from the real problem.  I would argue that they are an essential first step in a long road to reclaiming our profession.  We have been passive for too long as medicine has transformed from a one on one relationship with patients to a multi-billion-dollar industry.

If we consider an Olympic athlete, we would expect close attention to nutrition, movement, sleep, psychology, and mental focus.  Why would we expect ourselves to function at the pinnacle of skills, cognitive or surgical prowess, without the same attention to these self-care details? Techniques like mindfulness allow us to spend our moments in the present, to recognize our emotions and physical body.  This self-awareness allows us to acknowledge our human needs and the needs of our patients.  It makes it easier to disengage from our screens and consider the human we are treating.

Emotionally exhausted physicians who have gotten to the point that they don’t see their patients at people, who lack a sense of personal accomplishment often struggle with the idea that self-awareness could possibly help.  They call for rescue.  They hope of a magical solution. Unfortunately, that isn’t coming.  There is no quick answer or speedy recovery.  Many leave the profession in hopes of finding better shores, some take their own lives in despair.  I argue mindfulness offers us an opportunity to be angry, to consider the need to rise up and take medicine back.  Eighty percent of the problem facing physician wellbeing may be system issues, but it is addressing the remaining 20% that will put us in the position to advocate and change the system.

We are a gritty resilient bunch.  We can tolerate almost anything.  What we cannot tolerate is the move from medicine as a humanistic caring field to medicine as a business or commodity.  That is a reality that we cannot accept. We value connection with our colleagues, our patients, and their families. The good news is that self-care, conscious choice, finding meaning and purpose hone the skills that made us resilient in the first place. Medicine is a hard career and we won’t succeed by accident.  We will succeed by caring for ourselves and our patients while we lead the future of medicine back towards humanism and personal relationships. We will lead it back to a place where our expectations better match the reality: hard work, difficult decisions, long hours, but meaningful patient experiences and the satisfaction of a job well done.

locke

Amy Locke, MD, FAAFP, is an Associate Professor (Clinical) in the Division of Family Medicine which is housed in the Department of Family and Preventive Medicine at the University of Utah. 

2 thoughts on “The Case for Personal Resilience Strategies in Changing the Focus from Burnout to Wellbeing

  1. I was a health education teacher for 10 years and have since moved the being a health educator to stress management coach/lecturer to helping physicians deal with litigation stress, via seminars and one-on-one coaching. Yet I frequently go back to a concept I taught seventh and eighth graders in health education: A physician can move you from sick or injured to not being sick or injured; to move from that point to a position of wellness is a personal responsibility. There are many ways to deal with a system that creates burnout, but many of those changes are either not likely to happen or slow in coming. In the interim each individual must develop ways to become well and it starts with treating the symptoms of burnout, then making changes to move towards wellness. Think of this as a continuum with sick on one end, wellness on the other, and “not sick” in the middle.

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