Here’s the latest medical fad: Physician resiliency training.
Huh?
Doctors are already the most resilient people on the planet.
Doctors can go days on call without eating. I know. I have.
Doctors can go 24 hours without a bathroom break. (yes, we even have the most resilient bladders!)
Doctors can work 168-hour shifts with little or no sleep as detailed in this whistleblower video.
Doctors can tell parents their child died in a car wreck and then immediately run a code in the next room—without shedding a tear.
Doctors can each amass up to 500K student loan debt for the honor or caring for other people’s families while delaying or giving up their own childbearing, their own family, their own life—and all the while being funneled directly from residency into assembly-line medical clinics where they are abused. Yes. Abused. For their entire careers!
By the way, none of the above leads to “work-life-balance.”
Resilient means flexible, strong, sturdy, tough, and quick to recover. That’s the definition of a doctor!
We’re already so tough, sturdy, and strong we spend our careers as the human equivalent of a punching bag. Doubt me?
According to the UN Declaration of Human Rights: Article 5. No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. Article 24. Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.
Except doctors.
In my training, I assisted major surgeries with a full bladder, backed-up bowel, and a blood sugar of 24. My colleagues have worked hypoglycemic and sleep-deprived to the point of hallucinating and having seizures. There is absolutely NO organization that protects doctors who are routinely abused, mistreated, harassed, hazed, and humiliated.
Many of us have considered suicide, but we are so resilient that we smile and head back into the next room to see the next patient.
Please. Don’t train us to be more resilient. Train us to be more RESISTANT to abuse.
Hey doc, listen up. Have you been mistreated, injured, harmed, or damaged during medical school, residency, or by a health care employer?
Attention: Resiliency training will not help you. No amount of deep breathing will help you. No special yoga workshop for burned out doctors will be your salvation. You will never, ever, ever regain “work-life balance” while you continue to allow yourself to terrorized with fear tactics and trapped in an assembly-line clinic you hate.
Congratulations! You are already highly resilient.
Pamela Wible, M.D., is a pioneer is the ideal medical care movement and recipient of the 2015 Women Leader in Medicine Award. She leads physician retreats to help her colleagues overcome abuse and open their own ideal clinics.
Love this blog Pamela – so true!
good for you! i was at a conference where some residency faculty were pushing resiliency training instead of getting faculty to stop abusing residenta, same concept. like psychoanalysts used to teach women to be content with their barefoot and pregnant role. its the moral equivalent of training slaves to push through the pain of whippings so they can get massa’s work done, complete oppression.
Yep! Time to tell the truth.
I believe that the resiliency is with respect to the hospital-insurance-pharmaceutical complex, that we are threatened to embrace and join rather than face professional isolation and death.
It has nothing to do with full bladders or other described scenarios, although is may be related to an overly full rectum.
Does holding resiliency trainings have to mean that abusive behavior is not to be called out, when present? I surely hope not! If faculty members are allowed to be abusive to residents, something’s wrong in the system around them . . . and its resiliency is not sustainable.
I personally believe that solutions won’t come through any one kind of training, but can be developed through authentic, thoughtful explorations within each person and open conversations in each organization.
Best wishes.
Let’s hope the intentions of those who teach physician wellness trainings are to not only help physicians be well, but to help identify those individuals and systems that undermine the health of our physicians. Remember: medical students enter school with their mental health on par with or better than their peers. The decline in our mental health begins in medical training and then continues in physician workplaces. Teaching wellness does nothing to confront the true culprit that is undermining physician wellbeing.
I am a big fan of dealing with the root problem.
Goodness knows I’m a fan of dealing with the root problem also — no argument there. 🙂
I’ve worked with hundreds of suffering medical students and residents over the course of my career. Some of us come into this work hoping (unconsciously) to heal ourselves and our families. Of course this sets us up for pain. When the training system itself is sick (which it often is) then it adds more distress and contorts people who were healthier than others at the beginning. I know you realize that we can look great on the surface, yet have lots of pain going on inside. Please don’t forget that a lot of us have become the trainers, the educators, and “the system” — bringing our fallible, unhealed selves along in the process.
You’re of course correct that using a “resilience” model can backfire if it only pathologizes those less powerful, and avoids examining the entire community in which the training process is embedded. I hope you understand that this is NOT what I’m advocating. Blessings.
Have you been to or do you teach any resiliency training courses? Do you think that they are addressing how to confront the widespread abuse of physicians? Good skills to learn: What is an abusive employer? What is an abusive job? What is an inhumane velocity to see patients?
And yes, many of us come with our pre-existing wounds. Yes, many health systems are comprised of the wounded leading the wounded.
Docs are already in the top 1% of intelligence, compassion, and resilience. Ah, now to care for ourselves as well as we aspire to care for our patients. . . .
Dear Pamela,
I’ve been thinking deeply about your post, and understand where you’re coming from with it. Yet, I still see a role for resilience training — but NOT the kind that you’re arguing against here.
I agree that if “resiliency training” is offered INSTEAD of examining and improving our day-to-day lives and work situations, it misses essential points. It also suggests that “the problem” is physicians being too wimpy to “take it,” essentially. (As if we should beef up our “resilience” in order to shut up and maintain the status quo.)
However, an important part of resilience is the ability to notice reality and respond creatively to it. This includes when people are being mistreated, or when we need to take care of ourselves, etc. When we’re emotionally and physically numb from various kinds of exhaustion, our eyes and hearts are closed to these kinds of things — AND to any of our colleagues who might be suffering also.
Why we as humans would ever submit to the abusive behavior that exists in some medical training programs and work environments is extremely curious — yet we cannot ask ourselves these questions unless we keep our own wholeness intact. Physicians have to be truly awake so that we can help our own medical culture evolve. After all, we’re part of what’s perpetuating it as it is! Some of us DO need help restoring our own resilience, in order to do what’s needed for our patients, for ourselves, and for our larger society. And that’s why I’m NOT against resiliency training, Pamela. I’m for anything that helps us WAKE UP.
With ongoing respect for you and your work,
Pam
I think resilience is the wrong term for what physicians need. I’m all for any help we can get and I would love to help docs gain some insight into how they can be less disempowered and reclaim their own health so that they can properly care for others. Mostly what we need is the truth. The true numbers of suicided physicians and medical students. The true reasons why. The truth that is written on their suicide notes. The truth about what is not working about our medical education system. We need a reckoning with the truth—including taking back the vocabulary of our profession. Using the right words to describe the current circumstances that we find ourselves in. Without fear.
Some things that doctors do need:
Bereavement Rooms. Safe places to grieve at work.
Mind-Body-Spirit Re-Integration (to reverse the loss of integration from our reductionist training)
Mental health care (accessible, on-the-job, and off-the-record)
Other ideas?
I do feel and appreciate the spirit you’re working from here. You are calling for conversations which are very important, so I thank you for that. Yet I also think that what’s needed can’t be accomplished in any one seminar or training. To me, this seems to to be a long-term individual process which also requires support from others (educators, co-workers, loved ones, colleagues, friends, etc). The awareness that we even need any help is a huge step for many of us. 🙂 This might begin with various trainings, but continues as we ask ourselves individual questions and keep on moving forward in our own ways.
I do speak of enhancing physician resiliency and awareness — which I believe the solutions you’ve named will help support. The challenge AND the opportunity with this, though, is that we don’t all need or want identical solutions to heal our suffering. Long ago, Carl Jung MD said: “The psyche has a great desire to become whole, and to collect back its scattered parts.” I believe he was right — this is an innate movement in each of us. We can support each others’ processes through raising awareness as you are doing — and by truly hearing each other too.
Bereavement rooms can be a humane step . . . yet timing of use (if used at all) can’t be imposed. There can be ongoing “debriefing” (or other name) rounds to process what happens on our medical services: the patient deaths, suicides, etc. Learning should encompass not only facts and figures, but also human responses so that each team member has a chance to honor and make use of these. This can enhance personal wholeness and growth, and also solidify teams with trust and compassion. When anything happens on a team’s watch, it must be attended to. I feel that creating compassionate community anywhere we can, enhances ALL members’ resiliency. Physicians in private practice may find it harder to create such communities — but it is not impossible.
The “mental health care” aspect is a hot potato. When it is “on site” in a medical school, for instance, there’s always the possibility of administrative influence. This may unfortunately go against individual needs. Making time available for it off site (and making sure there are funds for it) CAN be accomplished though.
These things are only a start. I even think of “resiliency training” as a start. The idea of holding such a training indicates that someone has considered inner process important. We humans are amazing and can make use of the smallest thing, to grow.
Best wishes to you!
You are correct that doctors are incredibly resilient. If an administrator had to put up with a fraction of the emotional turmoil that we had to at work, they would be begging for an end to their misery.
Doctors are the most resilient on the planet. A few more examples (love to see administrators try these):
On February 15, 1921, Dr. Evan O’Neill Kane carried out his own appendectomy in an attempt to prove the efficacy of local anaesthesia for such operations. He is believed to have been the first surgeon to have done so. However, Dr. Wiener previously performed appendectomies (on others) with local anesthetic. In 1932, he performed an even more risky self-operation of repairing his inguinal hernia at the age of 70.
On April 30, 1961, Dr. Leonid Rogozov removed his own infected appendix at the Soviet Novolazarevskaja Research Station in Antarctica, as he was the only physician on staff. The operation lasted one hour and 45 minutes. Rogozov later reported on the surgery in the Information Bulletin of the Soviet Antarctic Expedition. Read about “Self-Surgery” on Wikipedia.
There is no question in my mind that doctors are resilient! So, when we, the doctors, make demands on the abusive treatment and abusive system. When will we protest and strike against the hospitals in order to have a normal lifestyle?
Time to resist or remain silent?
Think about, it!
Time to join forces!
Dr. John
I agree Pam. Resiliency is not what doctors, APP’s, nurses or anyone in healthcare needs. I don’t like the term resiliency when it comes to the physician as a new initiative from administration. It just makes people wonder what you are going to do to them next. We are all running at full capacity and as resilient as we can be at any given moment.
What we need is continuous redesign of the systems of care delivery to WRING THE KNOWN STRESSORS OUT OF THE SYSTEM on a continuous and ongoing basis. It is CQI … not building more resilient physicians that is most needed these days. But wait …
That would mean administrators would have to understand it is the wellbeing of the physicians/nurses that drives the quality of care. In other words …
They would have to CARE ABOUT THEIR PEOPLE. That is sadly not very common.
My two cents,
Dike
I absolutely agree that this mindfulness and resiliency “training” is just another corporate HR fad that amounts to cost-shifting and victim-blaming. The concept is basically poisonous and is yet another example of “paper hat professionalism” that is pushed by corporate executives. If everyone can be a professional, then being a professional is meaningless. Corporations want physicians who take orders, not give orders, and always get in line with an organizational manifesto.
Hi Pam. “Provider resiliency training” initially came into being as a military training program (specifically the Army) to try to help all types of Army healthcare personnel (including doctors) cope with the stresses of carrying out their duties on the battlefield without getting burned out and sick. Now it seems it has morphed into something in the civilian world. And I personally don’t like the looks of it. When “bottom line oriented” corporate medicine uses this type of tactic, it appears to me that it will end up being nothing more than indoctrination to force doctors to accept that working under the worst of conditions (conditions that are unsafe for both doctors and patients) is normal…indoctrination to accept abuse as normal.
Fascinating Colin! Thanks for the insight. I had no idea where this came from. I hope it was originally helpful for the military healthcare professionals. All depends on intent and leadership. Makes little sense to me in the civilian world when we are ignoring the elephant in the room—widespread bullying and abuse of medical students and doctors.
Pam,
I think generalizing about resiliency training is a dangerous game. I believe pre-existing personality and historical mental health issues are critical as well. The personality type is critical. Many med students have underlying bipolar spectrum disorder, and achieve exceptionally, but are prone to periods of depression. Medical students and physicians should be given a choice to participate in resiliency training. Your comments may be accurate for some, but additional coaching is also important to identify particular stresses for personality types, b-p disorder, ocd, anxiety, passive-aggressive and/or passive dependent personality types. Substance abuse must be identified to r/o self-treatment for any of the above. This can mask many underlying problems. Personality conflicts also add to stress disorders. A mix of some types can lead to outright dangerous acting out behavior. Your article does point out how well most of us do, even without help. ie, it either makes you stronger, or kills you. Your are a welcome addition to the assets we all have to continue to be productive and live a full balanced life. Now that i am retired I look back with a sigh of relief that I made it, raised five children, one of whom has cystic fibrosis (age 26)
Also managed to be married to a wonderful woman. (I am truly lucky)
Thanks Gary. In the end it is really the intent of the people who are teaching “resiliency” that matters. Do they desire to really help physicians and medical students or to further maximize profits and continue the abuse? It’s like domestic abuse perpetrators teaching a course for domestic abuse victims on “spousal resiliency” instead of seeking therapy for themselves as abusers.
Oh…Snap.
Resiliency training? It does sound a great deal like a culture that doesn’t “accept” or “believe” in emotional, verbal and psychological abuse because there are no bruises to see! Just take this class so we can fulfill some quota but go back to work and suffer the same abuse again….No changes to the brutality…it seems to put the doctor in the hot seat as “the problem” rather than address the abuse issues at the source.
I once asked an attending physician why we had to work a 36 hour shift with no meal or bathroom breaks. The answer: Continuity of care. Really? Are you the same doctor you were at the beginning of the shift versus the last 18 hours of that shift? Who else would be expected to work like that; not occasionally but for prolonged periods of time?
Who really stands up for us? Our malpractice rates go up and who benefits? The legal community….the insurance companies? Certainly not the patients and not us!
I hope that raising awareness to the ridiculous treatment of medical practitioners will help all of us to live a more balanced life; to not have to choose career over family most of the time and to actually enjoy the profession that we have been called to.
Pamela: You go girl!!!!!
As a physician coach, I have personally seen the benefits of resilience training. Indeed many physicians have thanked me for the new skills they have gained to help them navigate the difficult climate in medicine today. I do think this is not a mutually exclusive issue. We can have both – Addressing the broken, malignant corporatized system of assembly line medicine while supporting physicians to live the ideals that brought them into medicine. We need more than one solution for this Giant problem and as many hands on deck as possible. I stand here, inspired by the work of Pamela Wible and Dike Drummond and tremendously grateful for the insightful comments by Gary Levin and Pam Pappas. I am especially haunted by Dr. John Shigo’s words, since I have sensed that for a year now, that Physician Strikes are coming to the US. And As a US trained MD/MPH whose father died in a coma during Physician Strikes in Nigeria, I shudder to think of anyone going through the trauma of that experience… especially in the US! That said, our physicians have sacrificed everything for the medical profession and deserve much better! Solidarity!
Yes Doctors are resistant to showing stress but that does not infer that they don’t need help. I have an active support group of doctors and other high stressed individuals who hear my story with some knowledge of what to say or not say.
I judge that his support group is essential for my well being and it takes alot of pressure off spouse who has enough stresses just living with someone whose schedule even after training, precludes time for recovery .
I am scheduled to take a course in new coding requirements and how we are to implement this into our practices.
I will need my support group even more and will miss the attention that I ordinarily give to patients instead of making sure that I satisfy the needs of the controlling organizations.
We absolutely need more physician support groups! I think all high-risk professions (firefighters, police, medical) need on-the-job emotional support and counseling.
Nothing wrong with resiliency in and of itself (which is great!) but it misses the mark if it teaches victims to be resilient without removing the perpetrators of human rights abuses. Teaching resiliency to slaves without ending slavery misses the mark and teaching victims of domestic abuse to be more resilient without removing the spouse that abused them is missing the mark. Get it?
From Norman, a doc who requests I post his personal email response:
WTF is “resiliency training”?
Oh, I get it: we used to call it “Residency Training”!
Sounds like another smarmy blurring of definitions. My fav: “accountability” instead of “responsibility”. There’s a huge difference in meaning, guys!
Nice work, Pam, keep it going!
Norman
I’m not a doctor. I’m a patient and I feel like I have learned something profound here. Sometimes a person on the outside of a situation sees something more clearly than those on the inside. Like an abused spouse who doesn’t even realize they are being abused but it is clear from someone on the outside that they are being mistreated. You see the mistreatment, but far to many doctors don’t.
Doctors who speak up are a threat to a system where money overrules caring. Medicine is a corporate entity. As a hypothetical example, If an infant gets a vaccine and goes into seizures after a few hours and dies, does the system want a compassionate doctor who feels safe speaking out? Or does the system want a doctor who does as they are told?
The term ‘resiliency training’ is a con used against the doctors. The doublespeak convinces some doctors they are not being mistreated when in fact they are being manipulated. It is a clever method to break the doctor. The doctor is told “you’re strong because you can sever the emotional connection with a patient and you can also hold your pee for 24 hours.” but in fact, the Doctor has been broken because he has severed his emotional connection to humanity and also didn’t pee just like they were told.”
The way to really guage weather a Doctor is resilient is to measure his willingness to speak up to his bosses. When ‘resilience’ is deemed important, then speaking up becomes an act of weakness and doing as your told becomes strength. The opposite of reality. You are told you are strong when in fact you are broken.
Another dehumanizing act is hand over your own bodily functions to your boss. “When a Doctor is told to not pee, they don’t pee.” I would imagine peeing yourself would be embarrasing and foster an atmosphere of humiliation to keep doctors in line. This sounds more like a grade school bully who creates a situation so someone can be humiliated to satisfy the bully and keep everyone in line. It is a psychological ploy to dehumanize the Doctor so they will obey. Not even minimum wage workers are treated like that!
Resilience is doublespeak for obedience. Dealing with the problem of resilience training can’t be solved on the level of debating the merits or flaws of resilience. It has to be dealt with by discussing bullying. Even if Doctors could get rid of resilience training, bullying would still be there. It will show up in other ways.
RESILIENCE TRAINING EQUALS BULLYING.
You are one smart man Jerry! You got it!
Jerry – you had the most profound observations of all!
You, as patients (consumers), have more power than you know. Once patients become privy to the abuse, they have the power to affect change. When patients take their concerns to the board of directors of these health corporations – and say “I am dissatisfied that I only have 10 minutes with the doctor and AM GOING ELSEWHERE FOR MY CARE, things may change. Believe me, no doctor wants a 10 minute visit. It is an inhumane pace. Imagine if accountants or lawyers were forced to see 4-6 clients per hour. Neither the professional, nor the client would feel satisfied. The quality of visit would be very poor.
We are forced to work at an insane pace. We are told to go to meetings that incentivize us for “production”. We hold our pee. We stay awake through the night working, then work again the next day. We miss meals. We are told not to cry or show emotion. We are penalized for being “too thorough” in our evaluations.
Never again will I work for an assembly line practice!!!!! And I will stand with Pamela in helping to educate the younger generations of doctors to say ” NO” to abuse.
I’m standing with Ann. https://www.idealmedicalcare.org/blog/meet-the-happiest-doctor-in-idaho/
i underwent resiliency training at my last job at an Urgent Care that brutalized the doctors, but paid them very well at the same time. It involved reading books and getting coaching on how to improve patient satisfaction scores. A man from HR shadowed (with pt’s permission) me in the office several times and gave me feedback on what to say to patients and how to say it. Keep in mind, I’m a grown a$& woman who is board certified in family medicine who has sat on the boards of county health departments. But I was burned out, I didn’t give out enough antibiotics, my patient satisfaction scores were not high enough, and I needed to see more than my personal maximum of 36 patients per shift.
Something someone said in earlier comments resonated with me. I see a parallel now between two things: 1) physician burnout/collapse/a-ha moment when they are offered resiliency training and 2) the final straw that breaks an alcoholic/addict’s back, ie that person’s “bottom” before they are willing to give recovery/sobriety a try. Folks in recovery know that every addict’s bottom is different. For some it’s losing their job, for some it’s divorce, for some it’s their umpteenth failed attempt at sobriety. Sometimes sober folks watch a new person struggling, going back to alcohol or drugs again and say “I guess he/she hasn’t hit their bottom yet. They’ll be back to our recovery group when they finally hit their bottom.” I think resiliency training, and watching administration admit to you that their solution to burn out is not to help you but to distract you with more HR talk, is an a-ha moment. It’s when I saw how irreparably broken our system really is. Because if your employer is suggesting you undergo resiliency training, then you’ve reached the bottom. The dark underbelly is revealed…their version of help isn’t meant to help us. HR and resiliency training failed doctors the same way alcohol failed to work for alcoholics in the end.
Very true!!
You just made the case for why physicians need resiliency training! Resilience is like competence, you can’t call yourself competent if you don’t practice being competent. It’s not a destination, it’s a way of living.