As I travel the country giving talks to various groups of health care professionals about resilience-building and physician burnout, I sometimes come up against some resistance to the idea. The argument goes something like this: If our emotional exhaustion, depersonalization, and lack of a sense of personal accomplishment (i.e. burnout) is largely caused by work overload, administrative burdens, and the moral distress of trying to practice medicine humanistically amidst insurance denials, industry-prescribed time constraints, and patient quotas, why should I be the one being asked to become resilient? Shouldn’t my employer be the one to adapt and change? Shouldn’t the health care industry acknowledge their role in physician burnout and address some of its causes?
My answer is yes. Burnout solutions must start with buy-in from the institutions that employ us and the professional organizations that represent us. At an organizational level, institutions need to address issues such as providing work flexibility, robust staffing, and adequate time off to rest and recharge. Hospitals and clinics must deal with error management in a way that allows for growth instead of promoting shame. At the professional level, the culture needs to change from viewing physicians and nurses as heroes (as happened during the pandemic) to viewing all health care workers as human. We must move from a mindset of perfectionism to one of excellence in care and continual growth in our personal and professional realms.
But even in an ideal practice environment with maximum supports in place, cultivating personal resilience is beneficial. By the very nature of our work in medicine, adversity and loss will always be part of our jobs. We bear witness to great suffering every day, helping our patients through complicated illnesses and supporting their families alongside them. We absorb their grief and loss, trauma and pain. Although these events can be a source of great anguish for us, they can also be the source of our deepest reward. Developing skills that can mitigate the negative effects of those experiences while also mining them for areas of potential growth and learning remains valuable.
A reflective writing practice can help. Writing helps us to pay attention to the emotional experience behind the events we find stressful and, in so doing, helps us to better understand, process, and assimilate those emotions. Writing allows us to release some of the suffering we bear witness to that simply doesn’t belong to us so we can better focus on garnering meaning from those intense clinical encounters.
Besides simple release of emotions, writing also acts as an exercise in anxiety habituation. The more we tell our story, the less control it has over us. We also gain a measure of agency over our experience in the crafting of it on the page. We cannot change what has happened to us, but we can control our responses to them. We can mine them for meaning. We can experience personal growth.
Even when work is going well, writing has a role to play, as we learn to appreciate people and events that may have been taken for granted before our daily practice brought them to the forefront. Identifying resources, whether family support, environmental, experiential, organizational, or personal is critical in building resilience. Spending time writing reflectively helps us to build those personal resources. In taking the time to process our interactions with patients, say, we identify our inner strengths, develop our own practical wisdom, and cultivate an openness that allows us to consider new perspectives, all of which enhance resilience.
Studies have shown that greater resilience is associated with greater self-compassion and less burnout. The rules of reflective writing—that there are no rules, i.e., no grammar check, spell check, no right or wrong answer—are inherently self-compassionate and self-kindness has been shown to contribute to personal resilience.
Resilience encompasses not only flexibility and resourcefulness, but also creativity and imagination. Writing helps flex that creative muscle, encouraging us to view situations in new ways, to craft a meaningful narrative from difficult circumstances, and to identify our own inner resources even as we are drawing upon them. The act of writing reflectively not only builds emotional and psychological resilience but enhances our cognitive development as well. Concretely naming the attributes we possess deeply but may not have identified and owned allows us to tap into those inner resources as needed. This building of self-knowledge can be an extremely empowering exercise and a major component of resilience-building.
I understand not wanting to think about or build resilience. I wish my foster daughters didn’t have to be resilient either. I wish their dad didn’t die. I wish their mom wasn’t an alcoholic. But those things did happen and my girls did become resilient—impressively, beautifully resilient. I hope our institutions and leaders step up and improve our practice environments. But until and even if that happens, banking our personal resources and building our individual resilience is a practice that will only add arrows to our quiver. Building resilience takes a village. And we can do our part.
Carolyn Roy-Bornstein is a pediatrician.
