Following heated debates in the medical press and social media about the value of resilience training for medical students and doctors, this blog and the GMC’s #gooddoctor event in Newcastle on 16th July on the theme of resilience, provide an opportunity to put the record straight.
I am a Consultant Liaison Psychiatrist and Clinical Director of the not for profit social enterprise ‘Connecting with People’. Connecting with People has pioneered a strategic, evidenced based approach to suicide prevention, emotional wellbeing and mental health awareness, combining compassion and governance
We contributed to Sarndrah Horsfall’s external review of doctors who die by suicide whilst under GMC investigation. We suggested that medical students and doctors would benefit from emotional resilience training and that staff with line manager responsibility would benefit from mental health awareness training. We also suggested that everyone should know how to respond compassionately to others in distress and how to respond safely to people at risk of suicide.
Strategically increasing wellbeing and resilience
Wellbeing, as defined by the World Health Organisation, is when someone ‘realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community’. Medicine can be a stressful job and more than ever we need to ensure we have emotional wellbeing, resilience and resourcefulness. Importantly emotional wellbeing is not about ‘mental toughness’.
Emotional resilience is about adaptive coping skills, understanding and managing one’s emotions and seeking social support to enable the ability to ‘bounce back’ or even experience post-adversity growth following a stressful event. It is not only the ability to cope with stress but being able to thrive and flourish even in difficult circumstances. It is not about asking doctors to ‘grin and bear it’ and to handle intolerable organisational pressures or excessive workloads. Neither is it about the naming and shaming of ‘weak’ doctors for not being tough enough to cope with the pressures placed upon them. Quite the opposite, in fact.
People may not consciously realise that they can strategically increase their wellbeing and resilience. Sarndrah Horsfall’s recommendation that medical students should have resilience training followed her hearing about the training developed and delivered by Connecting with People. Several other organisations also deliver such training. This kind of training enhances emotional literacy, debunks myths associated with emotional problems, reduces the stigma and fear of talking about emotional distress, suicidal thoughts, self-harm and barriers to seeking help. It also promotes early intervention, the value of connectedness, of relationships, of self-care and of seeking support if needed. Seeking help is not a sign of weakness. It may be one of the bravest things a doctor ever does, and may even save his or her life.
Compassion starts with self compassion
Being a good doctor requires many qualities: compassion, knowledge, skills, perseverance, team skills, flexibility and willingness to learn. But perhaps the most important of these is compassion. And compassion towards others must start with self compassion. If we don’t look after ourselves, we may find it challenging to deliver effective care, be more vulnerable to burn out or a potential catastrophic responses if we experience a ‘failure’.
Emerging evidence suggests that improving a person’s mental wellbeing can reduce morbidity and mortality. Stress and mental health issues are the most common causes of sick leave [PDF] (to be off work) in high-pressure workplaces. Together they are the second biggest occupational health problem in the UK [PDF] after musculoskeletal problems. People can learn how to increase their resilience by adopting certain mindsets, behaviours, emotional regulation strategies, coping styles and by adopting helpful self-nourishing daily habits. Once people understand that they can build and maintain their emotional wellbeing and resilience, they can then commit to a personal plan of how they will do so, which ideally includes how to access further support if they ever need it.
Professional athletes know that pushing themselves at 100% of their capacity 100% of the time results in little or no long-term performance gain and will probably shorten their career. So they build ‘recharge time’ into their training routines. We could all benefit from the same approach when developing and maintaining emotional wellbeing and resilience. All doctors need a compassionate level of suicide awareness, a personal strategy of how to maintain their wellbeing and how to safely self-manage acute distress by having a ‘ready-made’ safety plan to fall back on should they ever become suicidal. They also need to work in nurturing environments that support and engage them, validate the particular stresses of their work, respect their capabilities and make provision for the need for reflection and self-care strategies.
I welcome contributing to the GMC event on resilient doctors and look forward to discussing practical and pragmatic things we can do to make doctors genuinely more resilient, not just toughen them up.
Find out more about the 2015 events, and register your interest in a place here. Information on 2016 events will be published shortly.
Dr Alys Cole-King (@AlysColeKing) is a Consultant Liaison Psychiatrist (Betsi Cadwaladr University Health Board) and Director ‘Connecting with People’ – a social enterprise. Alys is a member of the Royal College of Psychiatrists Patient Safety Group and has contributed to College Reports. Alys sits on the Royal College of General Practioners (RCGP) Mental Health Training Group, and has contributed to RCGP and RCPsych curricula and the All Party Parliamentary Group for Suicide and Self-harm Prevention.
- Alys Cole-King on The day I found out that stigma can kill (BMA)
- Connecting People’s work on stigma: Tackling Stigma saves Lives
- Alys Cole-King on Do you sacrifice friends and family for work?
- Niall Dickson reflects on why the GMC is delivering the Medical professionalism events and what we hope to achieve: Medical professionalism matters- Join the conversation
- Russell Cartwright, GMC Corporate Communications Manager, on the Bristol Medical professionalism matters events on the theme of collaboration which took place in Bristol last week: Medical professionalism matters –Collaboration