Revisiting the burnout issue
The literature is replete with data on the incidence of burnout, depression and suicide among physicians and yet few solutions are near. We read these reports with solemn faces, shake our heads at the atrocity of it all, and then return to our daily lives. We might take a moment to acknowledge we have experienced some similar challenges in our own careers. Yet, we are mostly ill-equipped to help ourselves overcome the stress of being a physician. We also read about clinician wellbeing and improving resilience, but do not necessarily know the steps to take to help ourselves. Even if we learn how to improve our already bountiful resilience, change often comes slowly, in a piecemeal fashion, maybe through reading, or from a seminar or two, or by chatting with those who commiserate with us.
What is resilience anyway?
Dr Gail Gazelle, in her recently published book, Everyday Resilience defines it well. Resilience is “a well of inner resources that allows you to weather the difficulties & challenges you encounter without unnecessary mental, emotional, or physical distress.” Gazelle goes on to describe how we typically respond to stressors in life, and she offers well-defined steps to better cope with the challenges life brings our way. Gazelle shares case reviews so we can see how common our own coping behaviors truly are, and then she challenges the reader to self-reflect by offering resilience practices to follow and tools to expand self-knowledge.
How I wished I had a guide like this 30 years ago! You could argue that I may not have been ready to self-actualize when I was twenty-five. But, I wonder how I might have fared had I not internalized being shamed by fellow residents after sharing that every other night call was a burden. How about the time a cardiovascular surgeon made demeaning comments to me in a roomful of colleagues? I might have compassionately recognized part of his method of control was to render sharp criticism. Experiences like this are familiar to each of us and Gazelle offers an introspective way to maneuver through such daily encounters.
How life might have been different
In the past several years, I have dedicated myself to studying the topic clinician wellbeing, mostly in an attempt to overcome my own burnout. I see how slowly I have improved my resiliency and increased my self-awareness. Reading Everyday Resilience made me wonder how much more quickly I would have come to some of this self-insight had I gently been told that my perfectionist tendencies might work against me, that being mindful and practicing self-care is part of a healthy routine, that I may often perceive I am “not good enough,” and that there are ways to overcome such feelings. What if a respected mentor had shared insights like those found in this practical manual? Perhaps my battle with burnout would have been more quickly won.
It is a lofty goal to consider defeating this burnout dilemma by helping those early in their training expand their well of inner resources to better weather the storm that is a career in medicine. I know many medical schools and training programs already offer assistance to their trainees in an attempt to nip burnout in the bud. There are as many approaches to this process as there are training programs. Some do it well and strengthen their flock, and others struggle with limited tools and unequipped mentors. I am experiencing this challenge currently with the trainees at my own institution. I am part of a physician coach team that has been tasked to assist the trainees in building resilience. Our team has thankfully discovered that Everyday Resilience is a superb guide for those of us who mentor and coach, but feel under-equipped to guide trainees in developing greater agency. We are using this resource, in a book club format, with our 110 residents and fellows.
I personally believe teachers of medicine have been given a gift in this small book, a way to help their trainees better persevere. Using Everyday Resilience as a guide, those who are dedicated to trainee well-being can lead discussions on how to strengthen resilience, improve self-care, better manage our emotions, improve communication and resolve conflict. What will medicine look like when the fire of burnout, that is consuming us and our future physicians, is finally squelched?