Medicine is a rewarding and endlessly challenging career. Hanging in for the long haul requires the ability to transcend adversity.

When we consider all the complex issues we juggle every day, sometimes it seems easier to try to ignore the frustration and just get on with the job. But chronic states of stress can catch up with us and if this happens, patient care will suffer. Most importantly, we need to challenge our medical culture, which tends to encourage us to wear our state of chronic stress like a badge of honour. For these reasons, all of us need to think about ways to maintain our resilience in the long term and how we care for our colleagues.

Looking after ourselves and building strong relationships are essential components of providing competent medical care to our patients. Here, we discuss eight principles for being a resilient doctor.

1. Make home a sanctuary

In any demanding career, it is essential to have a quiet sanctuary away from work. It is sometimes difficult to nurture personal relationships when working long hours or in different locations. It is tempting to withdraw from contact with family and friends on the weekends if we have been interacting with hundreds of people during the week. While making time for solitude is important for self-renewal, withdrawing socially from people regularly is a sign of burnout, which can lead to mental health problems.

Unfortunately doctors experience high levels of marital and sexual disharmony with partners, often due to the excessive demands of work. We can proactively choose partnerships and friendships that energise us and provide mutual love and support. As doctors, we often find ourselves adopting our carer role in our personal relationships as well as our professional lives. While this is inevitable, it is important to seek out people who will help sustain us.

Those of us with children need to be aware of the pitfalls of parenting and the challenges of balancing the responsibilities of being a parent with a busy professional life. We need to choose a parenting style that protects our children and allows them to grow into healthy, autonomous adults. By caring for our families and friends, we create a welcoming sanctuary at home — a place to relax and restore our loved ones and ourselves.

2. Value strong relationships

Strong doctors have strong relationships. As doctors we face excessive demands on a daily basis. To get the job done, many of us try to manage each day by unsuccessfully attempting to complete endless ‘tick lists’ at the expense of our professional and personal relationships.

We need to take time every day to nurture healthy relationships with ourselves, our family and friends, our patients, our colleagues and our physical environment. Anyone with the right training and experience can become an excellent medical technician. What sets excellent doctors apart are their strong, caring relationships with people.

3. Have annual preventive health assessments

As doctors, we each need our own doctor, someone whom we trust for our medical care and advice. If we are going to prevent major health problems, we must attend our doctor for regular, evidence-based preventive health assessments. This will allow early identification and management of the symptoms and signs of any physical or mental illness.

The early detection of serious illness saves lives and can prevent years of unnecessary suffering. As doctors, we deserve to have access to the same level of quality medical care that we provide to each of our patients. Our families also deserve this standard of care. Organise for a check-up today with a trusted colleague.

4. Control stress, not people

As doctors, we tend to have reputations for being overcontrolling. Whether this is true or not, many of us tend to develop driven personalities as an adaptation to the demands of our work. This personality can be a positive in the workplace, but can be damaging in our personal lives.

We need to accept that other people can’t be controlled and allow others to learn from the consequences of their actions. We need to learn to delegate and share care more effectively. Sometimes our patients, particularly those with special needs, benefit from a multidisciplinary team approach rather than the services of a single doctor working in isolation.

It is important to maintain feelings of control over our lives by managing the stresses we do have control over. Ignoring problems will not make them go away. Stress should not be worn like a badge of honour. We can take time to address the background stresses in our lives and to transcend difficulties by:

• Understanding our driven personalities and learning to take a break from these traits.
• Recognising and addressing signs and causes of chronic negative stress.
• Leveraging time and delegating tasks.
• Challenging our own negative thinking and beliefs.
• Aiming for wellbeing, rather than absence of stress.

5. Recognise conflict as an opportunity

This is not about seeking or avoiding conflict. It’s about managing conflict maturely when it inevitably arises. In order to deal effectively with conflict, we can recognise it as an opportunity to build stronger relationships with people.

If we have ever had a calm debate with someone over an important issue that concludes in a negotiated solution, we will recognise that our relationship with that person has become stronger. If we have ever amicably agreed to disagree with someone over an issue, we will recognise that the ability to have an open debate, even without resolution, has strengthened our relationship with that person.

On the other hand, avoiding conflict, non-assertiveness, hypersensitivity to criticism, refusing to listen or angrily squashing another person’s point of view can be destructive to relationships. We can become as expert at managing challenging behaviours and strong personalities, conflict and anger as we are with managing other aspects of our professional work. We can learn how to deal with criticism constructively.

6. Manage bullying and violence assertively

Bullying and violence are not acceptable behaviours and must not be tolerated. As doctors, we must know our responsibilities as employers in addressing cases of bullying or violence in the workplace. We need to be aware of how our own behaviours are perceived and strive always to behave in an appropriate professional manner.

Medical practitioners must become skilled in ways of assertively managing patient-initiated violence, and violent behaviour must always be reported to the police. Failure to do this often results in the violence being deflected onto another colleague or the wider community.

It is well-known that people with mental illness suffer a great deal because of the stigma attached to their disorder and they are more likely to be the victims rather than the perpetrators of violence.

7. Make our medical organisations work for us

Our medical organisations are charged with the responsibility for advocating about many of the issues that affect our ability to deliver a high-quality service to our patients and our communities.

These issues may range from areas of clinical interest, inequity in access to healthcare, clinical independence, training needs or the impact of the environment on health.

By becoming involved in our membership organisations, even in a limited way, we can gain peer support, develop areas of special interest and learn how our organisations work and how they can provide us with ongoing support and advice.

Our medical organisations can also provide opportunities for leadership training to support our roles in advocating for our communities and our patients.

8. Create a legacy

We can be proud of our profession. Each of us has the potential to be a role model for future doctors and contribute our own lasting legacy through the examples we set in the way we live our lives and practise medicine. It may be worth considering how each of us would like to be remembered at the end of our medical careers and act accordingly now.

Each of us has a set of values and principles that determine how we behave as ethical medical practitioners. In creating our legacy we can also discover ways to transcend the adversity we encounter as part of our professional lives. It helps to focus on big-picture issues that make a difference by:

• Finding meaning and purpose in our everyday work and rediscovering the joy of being a doctor.
• Identifying the qualities we admire in our role models, mentors and colleagues.
• Upholding our integrity in everything we do.
• Developing goals for all aspects of our lives including our spiritual life, our physical and mental health, our careers and our relationships with other people, especially those who love and support us.
• Personally supporting our medical and other colleagues.

Conclusion

Through our experience as doctors we learn how to deal effectively with the many joys and challenges of medical life. We have also learned some principles about protecting ourselves from harm and developing resilience. Most importantly, our patients and our colleagues have taught us about the true meaning of healing.

While ‘first do no harm’ has long referred to protecting our patients, in the 21st century its meaning needs to be expanded to also include protecting our families, our colleagues, our environment and ourselves.

If we are going to be effective medical practitioners providing care to each of our patients and contributing to healthier and stronger communities, we must not only avoid inadvertently harming ourselves, but also be proactive in building our resilience.

We must learn about the true meaning of healing.

Adjunct Associate Professor Leanne Rowe AM is patron of the R-Cubed initiative. Sheis a GP and runs a medical practice that treats medical practitioners in Melbourne. She is deputy chancellor of Monash University.

Professor Michael Kidd is a GP and the executive dean of the faculty of health sciences at Flinders University, Adelaide.

This article was originally published in Australian Doctor on 15 February 2010.