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Don't talk to me about resilience ...

RAHMAN: 'We are already the epitome of resilience'

Hollow words about coping and resilience are not only patronising but make doctors who face unsustainable pressures feel it is their fault if they are struggling, says emergency medicine consultant Shewli Rahman

I arrived for my on-call, parked, sat in my car and realised I couldn’t get out. This wasn’t a bad day, bad week, or even a bad month. I simply didn’t want to be a doctor any more.

I wanted it all to stop. I had been an emergency medicine consultant for nearly seven years. As with my colleagues, I was willing to work hard, to put in the long hours and to sacrifice time with friends and family. My father, a first-generation Bangladeshi immigrant, had instilled in me the belief that every problem could be overcome if you put in the right amount of time and effort.

However, after 20 years as a doctor, I had had enough; enough of the hostile conversations, the unrelenting pressure, the unsafe and chaotic working environment. I got through the day, hanging on by my fingernails. A few weeks later I resigned my consultant post and walked away from my job.

 

Overwhelming pressures

I came back after three years. I would like to say my working life has become more manageable. It hasn’t but I think I have learned a thing or two.

I don’t believe you should have to walk away from your job, or go off sick to cope with it. I don’t believe we should be made to feel ashamed, inadequate or not tough enough when we find our workload overwhelming.

Often, I have been told to be more resilient and I’ve said it to others, too. On the face of it, it seems harmless. Resilience is about recovering quickly from difficulties, adapting well in the face of trauma and adversity. Who doesn’t want or need to do that? But there are real problems in just bandying the word around.

The thing is, we are already the epitome of resilience. Every single day we share the joy and triumphs of those we come into contact with, we share their grief and loss, and sometimes, despite our best efforts, our patients die in front of us.

Then we turn up the next day and do it all over again.

We, in healthcare, do an incredible job and we don’t even recognise it. We should not let those who have not walked in our shoes say the solution to intolerable pressure comes from within us because this shifts the responsibility from those who could do something about the environment, to those who have to exist within it. This is simply wrong.

 

Finite capacity

So now I believe it is wrong to tell staff in the most pressured, conflict-ridden, inhospitable environments they should learn to deal with it. It is patronising. It makes people feel it is their fault if they can’t cope – they just need to be a little bit stronger.

We all have our limits. It is normal to feel overwhelmed by the work, the barrage of questions and the never-ending decisions – when our means to cope with the world around us is steadily eaten away by tiredness, hunger, rudeness and stress.

Our ability to care for others is vast. However, it is also finite. There are days when you just cannot give any more.

It is not a weakness. We need to be kinder to ourselves. And that is not a weakness either.

If you tell people they need to be resilient, you’re making it their job, and their job alone. However, it is a whole team which needs to be resilient. Healthcare is a team game; resilience is a team game.

 

Civility and compassion

Our teams grow better and stronger when we treat each other with respect. The Civility Saves Lives movement shows rudeness substantially reduces the cognitive capacity not just of those on the receiving end but of onlookers, too. Staff exposed to or just witnessing rudeness are more likely to make errors and much less likely to be helpful to the next person in need. What a devastating effect on an already stressed team. Rudeness destroys innovation and creativity.

The exact opposite of incivility is compassionate leadership. Remembering to say thank you, to ask people how they are and to care about their answers. King’s Fund senior fellow Michael West’s research has shown compassionate leadership equals reductions in mortality as well as improvements in staff morale.

This winter is going to be tough. NHS staff are already hardened. What have I learnt about resilience? Treating staff with civility and respect is part of the answer. Hectoring them to be even tougher and implicitly blaming them for a service facing unsustainable pressures is no part of the solution at all.

Contact the BMA’s Wellbeing support services on 0330 123 1245

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