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Are we really 'resilient', or are we just overexploited?

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The term ‘resilience’ has become the new buzzword thrown at GPs. The GMC has decided it should be enshrined into medical school training, hoping to prevent the scandalous rates of suicide among doctors under investigation. Over an eight-year period, 114 doctors under investigation have died and 28 of these have been confirmed as suicide. The GMC has been urged to change the mentality of ‘guilty until proven innocent’, but all this talk of resilience puts the blame on the GP for not being tough enough.

And I am still uncertain if resilience is something we should aspire to. My own interest stems from the fact that my father died unexpectedly when I was 16. The following day, I travelled alone to school, was given a cup of tea in the head teacher’s office, told to take the rest of the week off and to return after that. There was no mention of support or counselling. I kept my head down, studied hard and started medical school. Once there, I was distracted by my independence, the workload and partying. I thought I was strong. It wasn’t until three years later that it came crashing down. I was depressed (but didn’t seek help), left medical school (only to return a week later) and felt infantile. I had buried my grief, distracted myself, and the world saw someone who had ‘bounced back’; the hallmark of resilience.

Fast-forward four years and I was a junior house officer working more than 100 hours a week. In 1992, this was the norm. I was part of a collective resilience, akin to being in a war zone. We worked together, ate together, played together and slept together. We became agoraphobic when we left the battlefield and had occasional PTSD symptoms, but didn’t yet recognise them. Our only motivation was survival. We would not waste energy trying to improve conditions, as reflected by the European Working Time Directive legislating when the BMA could not.

Those of us who survived were now feeling pretty superior. We felt younger doctors lacked the resilience and professionalism of the past. But what did this resilience achieve? As trainees, we continued working overtime at nights and weekends for HALF our normal pay; being paid less per hour than the cleaner. We abused alcohol because that’s easy when you are sleep deprived. Our relationships were intense, but transient as we laid our hat in a new home every six months. And most disturbingly, we developed a black humour and armour that was impenetrable to compassion towards our patients or each other.

This is far from a successful story of resilience. It is a story of damage and exploitation. Our ‘professionalism’ has led to 12-hour working days combined with a loss of income. It is now preparing to work a 12/7 week. But true resilience would mean valuing ourselves, putting us, our families and friends first. It is no surprise that newly qualified GPs are rejecting salaried and partnership roles in favour of locum posts and working abroad.

We could learn a lot from them.

Dr Shaba Nabi is a GP trainer in Bristol

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Readers' comments (47)

  • Bye and thanks for all the fish

    Well written and full of truths. I think abuse sums up how our generation of young doctors were treated, and we are paying for it now.

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  • Excellent piece. I agree that resilience is an ambiguous virtue.

    "Resilience" may describe a healthy ability to feel and express shame, guilt, sadness, pain or anger, and then move on.

    Or it may describe emotional denial, burying ones feelings beneath "armour plating" until they explode in rage, depression, substance abuse or any other one of a number of final common pathways.

    As Orwell might have put it, when it comes to emotional health, "strength is vulnerability". I hope that those promoting the virtue of resilience remember this.

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  • Currently we have to be resilient and be able to cope with being governed, managed and lead by borderline sociopaths(if not outright sociopaths).

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  • Brilliantly written piece. Many thanks.

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  • Thank you Shaba.
    Wonderfully written, and refreshingly honest.
    I wish everyone in this profession was!

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  • Brilliant piece which reflects my feelings exactly.
    It would be very interesting to study the incidence of PTSD in doctors.
    Having spent 4 months in hospital as a 10 year old without my parents and with nurses who believed in punishment for any sign of distress, I was well trained for 100 hour weeks in junior hospital jobs. I learned to suppress my feelings, emotions and needs very well. I could have been described as very resilient.
    A further work related trauma tipped me into symptoms which I now recognise as PTSD. Panic attacks, flashbacks, guilt and depression.
    Having recognised this I will never, ever again risk my health and have left the exploitative world of general practice behind for good.

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  • Spot on!

    (Reminiscent in a way of Samuel Shem's "House of God" - one of the books that helped me get through.)

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  • I am interested in language use in cultures today and past.

    The recent GMC use of "resilience" "training" in response to Westminster Parliament struck me.

    "Resilience" now seems to be featuring more widely in healthcare and the NHS.

    This is not a trend I welcome

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  • Well said Dr Nabi.
    Like good proactive LMCs, Beds & Herts LMC has a great team of local GPs forming a pastoral care team for our constituents. We do our utmost to advise struggling colleagues to come to us early for help and support. But yesterday I heard from an appraiser that GPs are reluctant to approach even an LMC like ours - "If I show weakness it will be the end of my career" attitudes. I also frequently witness first hand how badly GPs treat each other. How do we overcome these problems as the workforce diminishes and workload escalates? And then we learn in this edition of Pulse that the sparse counselling services for doctors are being withdrawn. I continue to fight for dedicated, confidential, specialist health services for that really 'hard to reach' group - namely doctors: The NHS must support its most valuable assets.

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  • Una Coales. Retired NHS GP.

    Well written Shaba. I echo your sentiments. The 'resilient' ones are those that recognise and have the strength to walk away from an abusive and exploitative work situation. No amount of 'resilience' will allow a GP partner to successfully navigate a unilateral NHS contract with removal of crucial MPIG funding, seniority pay, increased workload and mindless bureaucracy. IMO it is designed to break the most resilient!

    The government has GP partners cornered as they may only threaten to resign en masse from a detrimental contract but to do this would need the BMA to ballot its members. This ploy has worked in the past, but alas, the current BMA leadership, GPC and council refuse to ballot its members on undated mass resignation from an unworkable contract. In my opinion, medical history may well remember this self interested BMA for betraying GPs by blocking GP partnerships from any form of trade union action or ballot.

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  • Well written Shaba. How I wish I had the skills to write as eloquently as you. You say it so well. Thats the problem with our profession. We are taught , or rather forced to, keep it all shut inside, trundle on regardless and produce the goods as far as service provision was concerned and to hell with ones own well being, proper training, nurturing of ones hopes and ambitions. Hamsters we were and meant to just keep running on the wheel, whilst the brown nosers got on with their business and moved up. Resilience is a good word, and may even be a good skill to have, but in our profession it basically means ` How to be a shmuck and end up losing your life ( sometimes literalkly) ` . Its not Resilience but opening of ones eyes thats needed, and as someone said... SOMETIMES, OPENING YOUR EYS COULD BE THE MOST PAINFUL THING YOU WILL EVER HAVE TO DO . Doing it will save you though. As Una states, we all have to learn to say NO and walk away.

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  • thank you Shaba, this needed saying. When I went through a period of stress 2 years ago the worst thing was feeling so guilty about the effect on my partners. I am so grateful that they ( including you!) were supportive and recognized my need to cut back for a while on an exceedingly heavy workload. Reflecting on this 2 years on I realize how important my support activities were - swimming and meeting with a GP colleague on a regular basis. Both of these were lost for a while and the effect was huge. I would also encourage other GP's to go to their own GP. Mine was immensely supportive and full of sensible suggestions - ask yourself if you are safe, learn to say no and tell your partners. I feel more resilient now as a result. What I don't know is how to prevent GP's and doctors in general from being exploited in the first place. We seem unable to act collectively to say no to excessive demands from governments and the public.

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  • Una Coales. Retired NHS GP.

    I love seeing everyone post with their own names! It means we are NOT letting 'the socialist system' intimidate us into anonymity, hiding and solitary confinement!

    Thank you so much Pulse for creating a safe haven for GPs to offload and discourse freely. General practice may be a very isolating job and once a newly qualified GP leaves VTS, they leave the weekly GP support group too.

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  • Doctors and other health workers are turning their own personal interests in mindfulness; resilience; meditation'therapy;Balint groups etc into an industry which may or may not be hugely lucrative but adds to their 'portfolios' adds a bit of a spark to their own lives by running events and 'retraining' for their peers but the whole thing is snowballing until the next craze takes hold. Resilience is also holding back and not getting drawn in to it

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  • Eloquently put. Thank you

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  • Well spoken Shaba. If the "resilence" we are required to acquire if actually how to cope with being bullied, by the media, and those that control contracts and funding at all levels, then I want none of it. Those are not life skills to encourage or be proud of. We need to learn to say no and stand strong. We are doctors, not magicians, and cannot do everything for everyone all of the time, as many seem to expect of us now. I shall stick to my own coping strategies of withdrawing when it all gets too much, and keep myself and my patients safer as a result.

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  • This kind of resilience is analogus to a particularly graceless and pastorally disastrous theology which says if your prayers didn't cure your cancer you clearly lacked faith. So you are condemned to your illness and spiritual failure and potential isolation all at once.
    Not resilient eh, so you fail as a Dr, suffer your deserved distress and as its your fault we won't support you!
    Potentially a very nasty justification of nastiness

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  • THEY WANT US TO BE RESILIENT PRECISELY DO THEY CAN EXPLOIT US!

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  • Sorry. .Precisely SO they can exploit us.

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  • My father was a 'single-handed' GP (now retired). When I reflect back over the years that he worked as a lone GP (we lived next to the surgery) I can now recognise the effects of the pressures and workload had on him and his family which came to a head when my mother died of cancer. His years of 'resilience' and 'coping strategies' crumbled and he eventually had to see his own GP but it was something he never wanted to admit to or talk about at the time.

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