When “resilience” becomes a dirty word

David Oliver: When “resilience” becomes a dirty word | The BMJ – July 2017 – David Oliver, consultant in geriatrics and acute general medicine

Though this article is about the British National Health Service, it applies just as much to the US these days.

We need to talk about “resilience.”  One dictionary definition is “the capacity to recover quickly from difficulties; toughness.”

Health Education England describes it as “the ability to bounce back—a capacity to absorb negative conditions, integrate them in meaningful ways, and move forward.  

Practising medicine has never been straightforward, and it has always required such attributes.

Doctors carry responsibility, risk, uncertainty, and self doubt.

We make difficult decisions and witness harrowing scenarios weekly—that’s the nature of being a doctor. And, being human, it can get to us.

But “absorbing” any unacceptably and avoidably “negative conditions” makes resilience a dirty word.

It shifts the blame and responsibility for doctors’ struggles away from what are often over-politicised, understaffed, underfunded, badly organised systems and onto individuals

Just like shifting the blame for limited functionality to the patient’s “catastrophizing” instead of the patient’s pain.

Physician burnout is well reported in the United Kingdom and internationally.

A recent survey of 3695 doctors who had graduated from UK medical schools in 1974 and 1979 found that 44% reported adverse effects of the job on their health and wellbeing.

the factors cited in the survey eerily familiar:

  • long hours,
  • excessive workload,
  • poor work-life balance,
  • compassion burnout, and
  • managerial and regulatory changes.

It’s an understandable impulse to give reassuring platitudes and shift responsibility for wellbeing onto individual practitioners.

But a resilient system is what we need: one that adequately recruits, retains, values, and supports its employees.

Here is additional commentary:

Branches bend and either bounce back or snap | The BMJ

As I understand it, Dr Oliver is simply saying that doctors can be helped to be more resilient individually, but we must never forget that however much we can improve the resilience of individual doctors (and nurses), if they are ‘bent too far by the system they will break’: and that breakdown must be laid at the door of ‘the system they are working in’ and not heaped on the shoulders of ‘inadequately-resilient doctors’ – however much various people might wish to ‘spin’ this away from systemic failures, to failures of individual clinicians within the system.

Same as pain patients being blamed for not being resilient enough and succumbing to Catastrophizing.

It’s a problem with our medical system, not with individual patients and doctors being “too weak”.

Just like with doctor’s problems, patients have a problem with body-wide pain, not with being too “weak” to tolerate it.

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