The word “resiliency” has been lauded, applauded, and buzzed about in talks about physician burnout. When I hear it, I tune out. My stomach churns. I feel sick. Why? Because physicians are resilient. We are, in fact, the walking, talking, breathing personification of the word. We cannot manage to get through medical school, residency, and boards, without being resilient. And remember, we do this by choice. Lots of schooling and academic demands. Inhumane hours. Little sleep. Extraordinary amounts of information to learn. High-stakes environments. Ignoring our bodies’ needs (sleep, food, bathroom — you get the picture). Putting patients’ and hospital programs’ needs before our own. Often before our own family. Life and death. Quite literally. Repeatedly. So when we are becoming emotionally exhausted, losing our capacity to engage or connect, and have a sense of decreased personal accomplishment, we must wonder why. Because we have seen, done, and endured a lot in our careers. That’s why when well-meaning wellness programs and burnout discussions talk about the “R” word, I shut down. And break out in hives. “Resilience.” Game over. Not listening. I am already resilient. And I do not want to hear about it from anyone else. Least of all, from a non-physician administrator who will give me some great tips on being even more resilient so I can be a more productive member of the team. Because that is often how this story goes. Nope. Not having it. So as I consider my very strong reaction to the word and what follows, I wondered, “What would help us then? If not resiliency, what might serve physicians better?” And in stillness, I heard, “Allow yourself to fall apart.” Huh. Sometimes we have to fall apart and feel the uncomfortable emotions well up inside instead of stuffing them down. Perhaps in medicine, we might sometimes confuse numbness and resiliency. We put aside our emotions to carry on to see the next patient or care for the current clinical crisis, and we never return to hold space for those emotions. So we shove them aside. Numb them somehow. And we might call that resiliency … at the moment. But those emotions go somewhere. They are energy, after all. And we know energy is neither created nor destroyed; so if it is not destroyed, where does it go if we do not intentionally come back to those emotions and hold space for them and allow them to be felt and acknowledged? Part of our culture is avoidance of pain; we don’t want to feel discomfort. The medical culture is even more heightened around this notion. Patients often expect little or no pain; our medical system calls pain a “vital sign,” much like blood pressure or a temperature. This view of pain has even contributed to the opioid crises we face in our communities today. Sometimes, we feel pain. And it has a purpose. And sometimes, we might have to be OK with discomfort. We don’t always need to take a pill and make the pain go away. Or to try to forget about it. We might need to allow it to be there. To sit with it. To acknowledge it. And acknowledge how we feel. Patients get sick, and sometimes despite our best care — they do not do well. Sometimes we have a pandemic and see more illness and death than imagined. Other times we have unjust health care systems and health inequities that, in reality, create two health care systems and varied outcomes. Unfairly. We may have political entities meddling in our ability to care for patients. All of this creates uncomfortable feelings. As doctors, we may feel pressure to know the answers. To just keep swimming like Dory in Finding Nemo. And in this fast-changing world, there are lots of demands on our attention and energy. We cannot pretend to know all the answers. We are still navigating the COVID pandemic, dealing with an acute on chronic mental health crisis, mass shootings in our communities, and the overturning of Roe. Not to mention the everyday challenges of practicing medicine in general. Many have dealt with immense loss — of patients, family members, and friends — during these past two-plus years. Shifts in working and schooling have occurred. Being flexible has been the lesson of pandemic life. But, the unknown can be scary. And asking for help can also be frightening for experts in their area. And for those who are not used to needing help. Those who have been taught to keep going and see the next patient. We may not feel it is OK to ask for help with a patient’s case, let alone to ask for help for ourselves. As doctors, we are adept at putting others before ourselves. So much so that we often do not recognize our basic needs, perhaps because we have ignored them for so long. “Am I hungry?” “Do I need to go to the bathroom?” “What do I need most at this moment?” Trying to be a juggler and keeping all the balls in the air without rest is not sustainable. Lactic acid will build. Your arms will fatigue. Something will drop. It is a matter of time. It is just physiology. No amount of resiliency will fix this. Because doctors are perhaps some of the most resilient people on the planet. Addressing health worker burnout was recently released as an advisory and top priority by the U.S. Surgeon General. It addresses the multitude of factors from cultural, societal, and organizational to health care systems, workplaces, and learning environments. Lack of personal resilience was not one of them. And yet, we will continue to go back to work each day under sub-optimal conditions, out of love and service to our patients and the communities we serve. Often to the detriment of our own needs and our own best interests. And I do not say that to wear that as a badge of honor. Quite the contrary. I say that to highlight the fact that so many of us are unaware that it is a choice. And, in my view, for any physician to be told to be more resilient — implicitly or explicitly — by anyone is unacceptable. Under any circumstance. Physicians may need to be less resilient. Let down their guards. Allow their humanity to come through. Fall apart just a little bit. Feel those emotions. Allow them to just be there. For a moment. And listen to what the heart whispers when it is permitted to speak. That is where truth lives. It is from that sacred place where burnout begins to heal. Source
