OPINION: The resilience myth: is it just in our heads?

Peter Brindley, MD, and Steven Reynolds, MD

We recently finished weeks of service in different intensive care units (ICUs) on opposite sides of the Canadian Rockies. Neither of us had the most crushing of weeks, but we both experienced sadness and exhaustion in ways that come from long hours coupled with tragedy for many, and the end of life for some. For too long, we had avoided frank discussions about our work environment and what drives us to work in the place we do and in the way we do.

Brindley P, Reynolds S. The resilience myth: is it just in our heads?.Can J Physician Leadersh 2022;8(3):108-109

https://doi.org/10.37964/cr24758

Nowadays, we try to take stock the morning after we return to the real world, and this often leads to a quick chat on the phone. As self-admitted “failure friends,” we do a quick mental pat down. We check our vulnerable bits first: that is to say, our emotional and mental health. Both of our thermometers suggested we were tired, mildly despondent, and bordering on listless. However, we both had administrative duties and research projects in teetering piles on our desks. We decided to sit in the rubble for a moment. After a few minutes, it was time to ask the question: are we resilient enough and, if not, are we to blame?

The physicians who we admired during training seemed imperturbable and made of steel. They would not be slowed down by a week in the ICU; after all, they had science to conquer and enemies to crush. We are now both mid-career physicians and like to tell each other that we are good at what we do. Surely, we should have ample skills to cope. If we can intubate and resuscitate, it should be as easy as ABC to manage our feral minds and sagging bodies.

Personal well-being matters. It is not only a matter of looking after ourselves so that we can look after our patients. After all, it is well recognized that fatigued, burnt out, and otherwise frazzled health care workers make more mistakes and cost the system more. In short, to do well you must be well. Ergo, a physician lacking resiliency could be a danger to patient care. If so, then physician, heal thyself.

Fortunately, there is no shortage of articles, committees, and workshops telling us how to grow our resilience. Unfortunately, who has the time? We have been told that resiliency is a muscle, so get out there and train. We are told that mindfulness starts with peace and quiet, so pretzel into that lotus position now. We know we need to exercise, ought to meditate, and need to rebuild the dam before the next storm. However, when exactly are we supposed to find the time, and how much of our hard-slogged money ought we to spend?

As cleverly summarized in the 2019 book, McMindfulness: How Mindfulness Became the New Capitalist Spirituality,1 well-being has now become an industry with products to sell. It also has its high priests and lowly sinners. It has morphed into a moral requirement during off hours rather than a non-judgemental aid. No more eating ice cream in your underwear or drooling on the couch while snoozing to Netflix. No, dear Doctor, get out there and seize some wellness — you owe it to your patients. Come on, be better!

Often things are best defined by what they are not. If so, then it is worth knowing that antonyms of resilience include fragility and weakness. However well intentioned, it now feels like not engaging in this resilience culture comes with a faint odour of failure. It also fuels a vicious cycle — “Oh no, now I also suck at meditation.” For a profession already driven by insecurity and the imposter syndrome, we don’t need further reminders of our shortcomings. We can even end up in an exhausting catch-22. In other words, we end up working on resiliency during time when we should really be working at nothing at all. The point is that, as a profession, we need to learn that you do not always have to “do”; sometimes you need to take time just to “be”.

The resilience industry also distracts us from awkward but necessary questions. For example, why does this job require so much resilience in the first place? Have we set ourselves up for longevity and success, or have we merely undertaken a 30-year endurance test? Why does our lack of resilience feel like a personal failing akin to the 65% we got in chemistry? At the very time when we should be doing less, do we instead simply lean in ever harder, become ever grumpier, and leave the building with little left for our long-suffering spouses and bewildered kids?

Medicine is a challenging and wonderful career. Moreover, many other jobs are similarly challenging, but without our job security or societal prestige. As such, it is important not to moan. Regardless, one of the rarely spoken-about issues in health care is that, to be truly empathetic, we often take a small dose of the patient’s distress on board. In other words, we need to let it in to understand it. Neuroscientists would explain this by talking about mirror neurons.2 In simple terms, these neurons recreate a small copy of the sadness within ourselves, as the first part of fashioning a response. In other words, resilience is needed so that we can truly care for patients and not merely process them. Resilience is needed so that we do not lose the humanity that led us into this profession.

In closing, resilience ought not to be a buzzword, nor a product to buy, nor a personal failing, nor a booming industry. Just as with our patients, it should be led by the simple principle of “how can we all help”. Instead, it feels too much like a crafty technique or cynical life hack so that we can endure crushing work hours or chase prestige and dollars. With a third of a career to go, we are eager to get it right, or simply just a little less wrong. It seems a shame to keep it between the two of us on a Monday post-call. Please excuse us if we have overshared. We will now get back to work. After all, there is a lot of work to do.

References

1.Purser R. McMildfulness: how mindfulness became the new capitalist spirituality. London: Repeater Books; 2019.

2.Winerman L. The mind’s mirror. Monitor Psychol 2005;36(9):48. Available: https://www.apa.org/monitor/oct05/mirror

Authors

Peter Brindley, MD, FRCPC, is an attending physician, critical care medicine, at the University of Alberta Hospital.

Steven Reynolds, MD, FRCPC, is an attending physician, critical care medicine, for Fraser Health.

Correspondence to:

Peter.Brindley@albertahealthservices.ca or sreynolds.md@gmail.com

This article has been peer reviewed.