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Developing Resilience in Medicine

Resilience, it’s the thing that makes a shitty situation feel rather normal. It just has this connotation as if it’s something unique which only a few people possess.

Still, our modern culture loves it when you can develop some skill or a unique advantage. It makes stand out among the backdrop of 7 billion people in the world.

I guess I’m referring to the setbacks we experience in our careers. From medical board investigations to malpractice suits, to burnout, to substance abuse problems, to mental health breakdowns. All of it.

Unfortunately, your medical career doesn’t allow you to be a simple human. Once you are granted a state medical license you are expected to be infallible. No mistakes, no flaws. You are expected to be a god – but you’re not allowed to have a god complex.

Coping Skills

Some people are more resilient because they have better coping skills. They assume that they developed those skills through hard work. Maybe because of deep reflection and insight.

Not sure if that’s always the case. One person gets cancer and they handle it well. But when their partner breaks up with them, their life comes crumbling down.

Still, if you have some decent coping skills in life, chances are you can develop them in other aspects of your life as well.

I did NOT cope well with my exam failures in medical school. It sent me down a very dark toilet spiral. I lost faith in myself. I catastrophized the exam results and made the problem even bigger.

But I eventually recovered from that. And because of that I developed great coping skills when it comes to test taking. I have less fear and anxiety and failing just means not getting the right grade. That’s all.

Resilience in Medicine

We need resilience in medicine. We need it because a medical career is stacked against us from the start. It’s you against the patient, the medical board, and the lawyers.

It’s a landmine of a career. And even though the practice of it can be really enjoyable, some of the other aspects require you to have tough skin.

If you’re not resilient then you’ll drown as soon as something happens. You get a patient complaint, you get investigated, you have a bad patient outcome, or whatever.

I am not sure if I’ve been resilient. A part of me thinks that I have. I went through a lot with my medical license but I’m still at it – still seeing patients. And I still want to contribute to medicine.

But I also feel rather defeated on the inside. Not that I think I’m a shitty doctor. It’s just that I’m not able to freely navigate my medical career as I once could.

It’s Just a Job

I’m still here. So I must have some resilience, right?

Medicine is just a job. It’s not an identity. It’s not a higher calling. I’m not the brilliant, infallible person society wants me to believe I am.

I say that it’s just a job because if you think of it as anything else then you might overidentify with it. You might make it part of your identity. And if that job disappears, a big part of you disappears.

Parents and family members always want us to think that we are so special because we are doctor. Oh, how good we have it and how much money we make. So jealous!

No, fuck that! Please don’t project your inadequacies on me. I don’t need you to put me on a pedestal just so you can tear it down when it’s no longer a romantic idea for you.

I’ve worked at a pet shop. I’ve been a dispatcher. I’ve worked as a mechanic. I’ve made money consulting. I’ve made money selling shit online. They are all jobs. That’s all they are – some sort of labor traded for income.

Being a Doctor vs Practicing Medicine

I know this is subtle but I let go of my identity of being a doctor a while ago. I did that back in 2013/14 when I first started working my way out of medicine.

My goal was to be financially independent so that I could leave medicine – to retire early, if needed. Or, so that at least I didn’t have to rely on medicine as my only means of income.

Being a doctor is an identity. It’s like being beautiful or being tough or being young.

Practicing medicine is something you do. Like taking a shit or picking your nose. Or, if you prefer something more civilized, playing tennis

I don’t take it personally if I’m constipated one day. And I’m not one to break my tennis racquet in half just because I had a bad day on the court. That’s because I’m not a world class professional tennis player – I do it for fun.

And I practice medicine because I enjoy it. And as soon as it’s not longer enjoyable then I don’t sit there doubling down on it. Instead, I start paving a path out of it.

The Story, The Narrative

I’ll be honest, I’m sick and tired of talking about my career blunders. It’s gotten so old. It’s repetitive and I have to answer all of the same questions with every new inquiry.

Still, it’s very important what my story is. The story I tell myself and the story I tell others. I call it my narrative.

Whatever the real facts are. Whether you were the victim of foul play, whether our employer took advantage of you, whether the jury just hated you … it’s all about the narrative.

If your narrative tells the story of a victim, if it’s you against the rest of the world, it’s hard for you build resilience from that.

I know what this career is. Maybe it’s not the same for everyone, I get that. I wouldn’t have believed myself when I was a young attending. I’d have labeled me as yet another jaded doctor and kept doing what I’m doing.

Victim Role

I have been practicing medicine long enough, with good enough intentions, and made enough honest mistakes that I consider myself a veteran.

I’m not victim of medicine. I refuse to play the victim role. I recognized the good and the bad about 3 years into being an attending.

I was in the fortunate position to do something about it. My decision? To become debt free and find another source of income.

I don’t want to look back on my life and think that I stayed in something which might make appear to be a victim or make me feel like one.

Mourning the Loss

Just because you develop resilience in medicine doesn’t mean you can’t cry. It doesn’t mean that you can’t mourn the loss of your once impeccable career.

And you don’t need anyone’s permission to feel sad. It does suck. And I get you and I feel for you. It’s horrible when you are dragged before the medical board or have to answer accusatory questions by a lawyer.

Many of us never mourned the loss of the joy of practicing medicine. We never resolved the clash of the robotic nature of seeing patients with the loving nurture required to maintain presence before a hurting human being.

I genuinely miss how much I used to love practicing medicine. The new cases, the energy I had, the passion for learning. And when these feelings were fading I didn’t spend any time exploring the change.

Moving Forward

The tasks I’ve laid out for myself in life are simple: be a good person and be productive. There is nothing about being a doctor

I focus on moving forward and I am in search of the kind of work which is meaningful. I might never find that or I might find the perfect opportunity tomorrow.

And what might be the perfect fit today might turn out to be undesirable in a few years. Which is why I think it’s important to keep moving forward. Growing as a person, enjoying the work, avoiding suffering.

There are so many opportunities for us as physicians to make money. Making money from your laptop has become, in fact, the norm.

One reply on “Developing Resilience in Medicine”

well said Mo!

I think focusing on being resilient is one aspect a lot of “joy of medicine” and “physician burnout” programs don’t address properly or try to substitute mindfulness, meditation or yoga as the solution.

For me, “resilience” really has been about owning my story and realizing that I have the power to change it.

Glad to see you make that point here as well.

Not happy with working 6 days a week and doing mindless EMR scut-work? Rather than suck it up for about 15 years, I looked for different physician job opportunities outside of primary care and ended up working Urgent Care.

Don’t like the new physician administrators that came on after I was hired? I can’t change that, but I can tell them I’m not happy with the new situation and when things don’t improve, be resilient enough to know that leaving that job is part of moving forward and writing my next chapter.

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