As I journey across the nation delivering presentations to different groups of health care professionals concerning resilience development and physician burnout, I occasionally encounter some pushback regarding the notion. The reasoning typically resembles this: If our emotional fatigue, depersonalization, and absence of a sense of personal achievement (i.e., burnout) are primarily driven by workload pressures, administrative tasks, and the moral quandaries of practicing medicine humanely amid insurance rejections, time limitations dictated by the industry, and patient quotas, why am I the one expected to cultivate resilience? Shouldn’t it be my employer who adapts and transforms? Shouldn’t the health care sector recognize its part in physician burnout and tackle some of its underlying causes?
My response is affirmative. Solutions for burnout must initiate with commitment from the institutions that employ us and the professional organizations that advocate for us. At the institutional level, organizations must confront challenges such as offering work flexibility, sufficient staffing, and appropriate time off for rest and rejuvenation. Hospitals and clinics need to manage errors in a manner that fosters growth rather than instigating shame. On a professional level, the culture requires shifting from perceiving physicians and nurses as heroes (as was observed during the pandemic) to recognizing all health care workers as human beings. We ought to transition from a perfectionist attitude to one that emphasizes excellence in care and continuous growth in both our personal and professional lives.
However, even within an optimal practice setting equipped with extensive supports, nurturing personal resilience proves advantageous. By the very essence of our medical profession, adversity and loss will perpetually accompany our roles. We witness profound suffering daily, assisting our patients through complex illnesses and supporting their families along the way. We absorb their grief, trauma, and pain. While these experiences can be sources of significant distress for us, they can also provide our deepest rewards. Cultivating skills that can alleviate the adverse effects of these experiences while simultaneously exploring them for potential growth and learning retains its worth.
Engaging in a reflective writing practice can be beneficial. Writing aids us in focusing on the emotional experiences underlying the stressful events we face, enabling us to understand, process, and integrate those emotions more effectively. Writing affords us the opportunity to release some of the suffering we witness that isn’t ours to carry, allowing us to concentrate on deriving meaning from those intense clinical encounters.
In addition to simply releasing emotions, writing serves as an exercise in anxiety habituation. The more we articulate our story, the less power it holds over us. We also obtain a degree of control over our experience by shaping it on the page. While we cannot alter our past experiences, we can govern our reactions to them. We can seek meaning within them and pursue personal development.
Even when work operates smoothly, writing maintains its significance, as we begin to value individuals and events that may have previously been overlooked, now brought into focus by our daily practice. Recognizing resources, whether familial, environmental, experiential, organizational, or personal, is crucial for fostering resilience. Dedicating time to reflective writing allows us to cultivate these personal resources. By taking the time to process our patient interactions, we uncover our inner strengths, develop our own practical wisdom, and nurture an openness that encourages us to consider fresh perspectives, all of which bolster resilience.
Research indicates that higher resilience correlates with increased self-compassion and reduced burnout. The principles of reflective writing—that there are no strict rules, meaning no grammar checks, spell checks, nor right or wrong answers—are intrinsically self-compassionate and have shown to enhance personal resilience through self-kindness.
Resilience not only includes flexibility and resourcefulness, but also creativity and imagination. Writing exercises that creative aspect, prompting us to view situations from new angles, to construct a meaningful narrative from challenging circumstances, and to recognize our inner resources even as we utilize them. The act of reflective writing not only develops emotional and psychological resilience but also aids in cognitive growth. Clearly identifying the qualities we possess but may not have acknowledged allows us to draw upon those inner resources as necessary. This process of building self-awareness can be profoundly empowering and a significant factor in fostering resilience.
I comprehend the reluctance to contemplate or cultivate resilience. I wish my foster daughters were not required to demonstrate resilience either. I wish their father had not passed away. I wish their mother were not an alcoholic. But those realities occurred, and my girls indeed became resilient—remarkably, beautifully resilient. I hope our institutions and leaders will rise to the occasion and enhance our practice environments. Yet, until and even if that transpires, investing in our personal resources and developing our individual resilience is a practice that will only fortify our capabilities. Cultivating resilience necessitates a community effort. And we can contribute our share.
Carolyn Roy-Bornstein is a pediatrician.