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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)

  • Well said and written Shaba, not just the exploitation, damage and abuse during our junior years but the ongoing battle we have fighting for our NHS and fighting for our profession. Maybe we are too proud to admit it but we need a collective strength to stand up for one another. bullied and harrassed by the media, constantly managed by governments, revalidation, GMC, NHSE, and our own personal battelefields... I think just showing up at work is resilient enough :)

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  • great analysis from David Shepard

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  • 5.49, be careful. I used to respond in my own name until I found myself being quoted in the tabloid press.

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  • Having been to a 'resilience' study group recently, I soon realised that my definition of resilience and the current definition being attached to this latest 'buzzword' varied massively. The definition of "an ability of something or someone to recover and return to normality after confronting an
    abnormal, alarming and often unexpected threat" is slightly ambiguous. Does it mean we should just 'smile' through the good and bad times learning coping strategies to deal with what ever is thrown at us or does it mean we should react positively (and that includes resisting change!) and look to change our ways and working practises to enable us to remain positive? Part of the definition of resilience should involve structuring our 'environment' to deal with the change - something that is never included in trying to understand resilience. I felt the study group only seemed to look at superficial ways for GPs to 'cope' through change (e.g think of 3:1 positive to negative thoughts for the day) which was rather like saying "I'm happy to carry on in these poor working conditions and just pretend it's not happening." Having been so disappointed with the overall response of the group, I handed in my resignation as a GP partner and trainer, made several changes to my working life and have been 'resilient' enough to return to my former self! There's more to resilience than you think!

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  • 'The BMA could not'. Is there a duty of care to doctors ? If so , who from ? The Trust or Organisation or their Union - The BMA?
    Who should look after doctors so that they do not do 120 hours, or as I have done and so many others weeks of work with no time off ?
    Are we different from the rest of humanity in that we have no rights to a work life balance.
    Dr Sassa - Caltrop's prize winning essay in the BMA news review of Nov says exactly the same thing - 4 days and 3 nights with 3 hours sleep.
    But this is not the past. Consultants still do these 80 hour weekends. No EWTD protection for them.
    So, where is the duty of care to doctors from their Union?

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  • The definition is important here. Dr Nabi's honest piece highlights how negatively "resilience" can be interpreted. The concept of teaching resilience is one I have been in favour of for some time, but as Dr Nabi says, this should be "true resilience": the ability to stay true to your values, knowing where you can find pastoral, or other, support, having the skills to say "no".

    The GMC Chair wasn't wrong when he suggested that we will be subject to complaints, a lot more now than in the past. Ergo, we need to recognise this and have coping strategies. Half of them don't go anywhere after all and are not worth the stress they cause. Resilience in this regard is surely desirable. If this is also combined with access to support, NHSE, GMC and others being fair and honouring the duty of care they must surely have, well, then I have no problem with resilience training.

    In the wider world of impossible hours and impossible expectations, if we are better equipped to change things, stay true to ourselves and say "no" when we need to, again, I have no problem with resilience training.

    What we do have to do is ensure that it is true resilience and not acceptance of exploitation, that is taught.

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  • Anon 11.18 groups can behave like sheep all too often, they like to please
    Was it a group specifically gor medics though?

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  • Dear Shabi ,
    This is such a well written piece that it deserves national publication and recognition , so that the general public knows the reality of GP's plight . It is very timely . Why not submit it as a letter to the national newspapers ?

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  • Really wonderful article, well done Dr Shabi. I do fear that resilience is just a fancy way of saying "keep your head down, don't complain and get on with it". In reality being resilient doesn't mean keeping on going until you have nothing left. I often ask myself, what would I say if it were my sister/friend/a patient....

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  • It says a lot when a 'caring profession' can only turn up to work in the morning wearing a full suit of psychological armour. How did it come to this?

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