A Dirty Secret

Okay, deep breath…time to come clean…

I think resilience is important.

There, I’ve said it. But wait, there’s more!  Not only do I think it is important, I think we should educate staff to understand what resilience is and help them to become as resilient as they can be.  I think it just makes sense because we all know that life can be tough and that we are going to face difficulties.  Resilience is about helping us to be able to experience these problems with as little negative impact as possible and to move on in as positive a way as we can.

So, why would I feel awkward about admitting I believe this is a good concept?  Well, in recent times the response to resilience appears to have become polarised to essentially two positions:

We didn’t need resilience in my day: I coped with much worse so surely they can manage without this ‘resilience’ thing.

or

We don’t need resilience training: this is just an excuse to blame us for not coping and for the organisation not to sort out our working conditions.

Follow any thread on social media or listen to a meeting of staff and eventually this is what you are left with.  Those of us who think resilience is important are pitied by one side and hated by the other.  We are the moderate dog that both opposing sides want to chase off their field of play.  So, to people holding either of these positions, here is why I continue to believe and teach that resilience training is important.

We didn’t need resilience in my day: I coped with much worse so surely they can manage without this ‘resilience’ thing.

The first thing I’d say is, was it really much worse?  Now, I’m of a generation in the NHS who worked over 100 hours a week, got paid 50% for any work beyond 40 hours and barely had support from my senior colleagues after 5pm.  The juniors I know work less than half the hours I do, have better remuneration for overtime and are supported much, much later in the day by senior staff, even 24/7 in some places…that seems better, doesn’t it?  However, I have also witnessed a significant change to the way they work compared to my experience: the increased volume of work, the complexity of cases and the rising expectations they face.  I had time to go the doctor’s mess and play a frame of snooker or watch TV, most of my patents had single diseases and recuperated for days before being discharge and nobody was judging me daily against the latest protocol, policy or target for this disease or that procedure.  Not only that, I could go to the canteen at 3am and have someone cook me a bacon sandwich to order and, whilst I wasn’t there very often, I could at least afford to buy a house – if I chose not to live in the free/subsidised hospital accommodation!  I have come to terms with the fact that what we experienced wasn’t worse or better it was just different.  We can argue about which bits have gotten easier and which have gotten harder but it sometimes feels like arguing over whether you would rather be shot or stabbed…neither option is great so let’s concentrate on ways of not having either happen!

The second question I’d ask is, did we really not have resilience back then?  Just because we didn’t have a specific name for it doesn’t mean it wasn’t there.  We spent so much time at the hospital we developed deep relationships with a multidisciplinary ‘work family’ who understood what we were going through and who we could talk to freely without fear of judgement.  There was also a sense of belonging, of tribal protection, within our firms, our specialties and our profession.  Whilst our bosses could be hard taskmasters, they also protected us from external threats, wherever they came from… nobody else got to tell us what to do!

Whilst we worked long hours we also played hard: we may have been tired physically but we were young and recovered quickly.  Many hospitals had social events and doctor’s mess parties because so many staff, doctors and nurses, lived in hospital accommodation or nearby.    Outside of work we had sport, music and other pastimes to distract us with family and friends for further support.  Also, let’s not forget how we used other, less helpful strategies such as alcohol, sex and drugs to cope with the stresses of our work and the negative consequences of using these were often long lasting.  Just because we didn’t talk about the suicides, alcoholism and broken relationships doesn’t mean they didn’t happen.  To pretend we didn’t have resilience strategies or wouldn’t have benefitted from resilience education is to rewrite our history and we need to be honest about this before claiming otherwise.

So what of the other position…

Resilience training isn’t what we need: this is just an excuse to blame us for not coping and for the organisation not to sort out our working conditions.

You feel overwhelmed, at the end of your ability to cope and then someone comes along and suggests if only you practiced mindfulness, ate chia seeds and hugged your children more you’d be able to cope.  Yeah, because the empty rotas, systemic underfunding, micromanaging bosses, lack of equipment, straightjacket policies and unrealistic targets can all be ignored if I just sort myself out!

Believe me as a post burnout case I really understand your pain.  There are major, systemic problems in all healthcare systems and this need to be addressed at local, national and global levels.  Fight for change at any level you can, support those who do and never be afraid to stand up and speak out when change needs to occur…BUT just because I am pro-resilience doesn’t mean I am anti-system improvement any more than me being pro-sunscreen makes me anti-ozone preservation.  We can engage with the resilience agenda whilst still recognising and fighting for meaningful changes in working conditions but the danger in failing to recognise this is that we deny ourselves an important career survival tool.  Don’t let out anger or frustration at our working conditions blind us to the fact that we need to develop resiliency strategies.  Even if we had better hours, better equipment and better staffing levels we are still going to face significant problems in our work and personal lives: patients die unexpectedly, medical errors happen, marriages break down.  When events like this happen our levels of resilience are what help us through and it would be such a shame to have avoided advice and training because we didn’t trust our employer’s motives.

 

At the end of the day, we are colleagues working in difficult circumstances and we need to spend more time working together to support each other and less time arguing over who had it hardest or is mentally tougher.  Instead, we need to unite behind projects to change our working conditions whilst at the same time ensuring we are prepared to face the inevitable challenges our careers will throw at us.

Resilience matters and I’m not ashamed to say so!

Simon

Note: This blog post has been planned for some time but the final push was reading this incredibly sad article.

Resiliency Training in Medicine is a Farce

Here a doctor manages to simultaneously hold both of the positions above…effectively damning themselves and their future colleagues to a continued cycle of abuse.  What sort of situation have we created that drives someone to this?  We must do better.

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