Building Resilience during Challenging Times
Resilience at the workplace and in communities
An extract from a diary as FY1:
Today I was presented with a few unexpected setbacks. A patient I have been treating for more than a week took a turn for the worse. I was bleeped about 4 patients in a row including a patient with chest pain, a patient with low blood pressure & post-operative pyrexia, and a patient with melena. The workload seemed never-ending with the emotional toll being palpable. I have done this multiple times but every time I encounter a new challenge. I spent the next few hours attending to the most urgent tasks first and coordinating the rest with the other members of the team.
A few moments later, I found myself in the ITU with the septic patient surrounded by a team of critical care professionals. With a blend of expertise and experience, they managed to stabilize the patient.
As I sat down to reflect on the day in the staff room, I realized the importance of resilience in our profession. Resilience isn’t just about bouncing back from adversity. It is about finding strength and purpose in the middle of chaos and renewed trust whilst going through the challenges.
Some of the important things that came into play included learning how to process emotions, feel the disappointment and acknowledge that success is not about getting everything right the first time but accepting it as part of the learning process.
Just before the shifts end, I am reminded of our shared humanity. We are all travelers, navigating the complexities of our lives. As I make my way home and the hospital gradually departs from view, I carry with me the renewed expectation to return, ready to embrace the next challenge posed by the week-long of on-calls.
As my head hit the pillow, my mind drifted towards all the things I could have potentially missed. One of my patients who was in extreme pain and I prescribed them analgesia was the first to come to my mind. I did not get a chance to check on her during the chaotic last hour of on-call. Guilt-ridden, I remembered another patient who was 13-year-old and his eyes were filled with fear, as his family asked me a long list of questions. The reassurance I was giving was interrupted by another bleep of a sick patient. Fortunately, I was able to hand it over to one of my colleagues. Hopefully, tomorrow I will have more time for compassion and connection.
Taking a deep breath, I try to close my eyes and let everything fade into the night. I found comfort in knowing that being in such a position is a privilege and being a physician is more than just treating numbers it includes a human in front of us.
Resilience:
Linked to workplace resilience, here is a summary of some of the findings from the Office of National Statistics on suicide by occupation over the past three decades. These graphs provide insights into the occupational trends amongst males and females. Whilst the specific findings may vary depending on the study and the population examined, some general trends are shown below:
The risk of suicide was elevated for those in culture, media, and sports occupations for males (20% higher than the male average) and females (69% higher)…for females, the risk of suicide among health professionals was 24% higher than the female national average. In 2022, male individuals persisted in comprising three-quarters of the total suicide deaths recorded. Throughout 2022, the suicide rates among both males and females remained stable with the rates observed between 2018 and 2021.
Some of the evidence-based tips to promote resilience in the workplace include regularly prioritizing self-care, reflecting on positive experiences, taking every opportunity to expand knowledge, investing in staff wellbeing by creating a supportive and productive environment as well as adapting to difficult circumstances. Providing training in the workplace is vital for combating stigma and improving access to mental health resources.
Interventions such as CBT and mindfulness exercises have been around for a long time. In a systematic review, programs were stratified into CBT (cognitive behavioral therapy), mindfulness-based assessments or mixed interventions (CBT + mindfulness). The meta-analysis, encompassing 11 studies, concluded that interventions based on Cognitive Behavioral Therapy (CBT), mindfulness, and mixed approaches were all beneficial. The estimated standardized mean difference, a measure used to assess the difference between two groups, was 0.44. This indicates that the intervention group experienced a more significant positive effect than the control group.
In terms of the general population, evidence suggests that population groups who have been exposed to social and economic disadvantage experience differential access to timely and high-quality mental healthcare. Initiatives aimed at raising awareness about mental health and reaching out to communities, especially those who struggle to identify their mental health needs or trust mental health professionals, could provide valuable support to these groups. Additionally, addressing these challenges necessitates a more comprehensive approach to measuring access than what is currently employed in research. Addressing inequalities in access to mental health services could be better informed by a “wide range of research methods which attempts to contextualize access to mental health in a holistic way, such as considering mental health need, help-seeking behavior, and healthcare utilization.”
So why did I strike this year:
With the increase in the cost of living crisis, increasing pressure on the NHS, and 26% pay cut since 2008, junior doctors are being forced out of the profession. According to the BMA, more than 50% are struggling to pay their utility bills and are finding it difficult to make ends meet. Members of the BMA in England want a 35% pay increase and in Wales, junior doctors remain in dispute with their government over pay and have taken strike actions.
In conclusion, it is a profound gift to be in such a profession as every day we are given the opportunity to make a difference. Despite the challenges, I am incredibly grateful to my colleagues and everyone else involved for their hard work. Thank you for all you do.
