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Mukta Panda, MD, MACP, FRCP-London

How do medical professionals live as whole people, caring for their own health and heart as they care for others?

Anxiety, uncertainty, competition, and hopes to succeed in medical school can be overwhelming. The desire to do well at any cost is an intrinsic drive that can become dangerous without self-care. That's why resilience is so dynamic. It's vital to recognize when we are overwhelmed and to stop dwelling on emotions that don't serve us or others.

Too often we settle for delayed gratification, saying, “When I get through medical school or residency and training 8, 9, 10, or more hours of work every day, I will live my life.” However, this is our life and our work is living, so let us name and claim it as such and not make home and work mutually exclusive. Let us break down the barriers of our compartments and live a connected and joined life. Resiliency ensures a whole life, not a quick fix.

While there are many definitions of resilience and grit, here is how I define them. Grit is the passion that drives our purpose and perseverance to achieve in spite of all odds. Resilience is the ability to recharge, recover, rise above, and thrive in spite of all obstacles. I used to think that to be resilient I needed to acquire a skill—that I could attend a training course and then suddenly become a master at resilience.

How can we recharge ourselves in real time, even while on the job? After all, work is part of life, not separate from it. How can we slow down, quiet the noise of the world, and replenish our own well-being?

Here are eight ways to rejuvenate and recharge in real time, especially in challenging times:

1. Ritual. Just as the art of taking a history and performing a physical examination is a ritual, make a ritual out of taking a break. A ritual has a personal intentionality and mindfulness. As we practice these rituals, our attitude is important and contagious. Our mindset impacts our emotions; our thoughts; the words we speak; and, ultimately, the impact we have on ourselves and others.

   • I start my day with an intentional effort to smile, offer gratitude, and think or read something positive.
   • I love quotes; finding one every morning and sharing it with a reflection prompt has become a ritual for me.
   • Spend some time each morning—even a few minutes—in a practice that centers you, such as deep breathing, meditation, or prayer.
   • During the busy day filled with patient rounds, meetings, lectures, and frequent distractions, these practices help me be intentional and present. Acknowledge people intentionally when you meet them. Ask your team how their day is going and how the previous evening was.
   • Devise a “doorknob sign.” Before I enter a patient's room, I pause and remind myself of something personal about the patient that identifies them as an individual. This doorknob sign is valuable, because it ensures that I center myself before I enter each patient's room so I can focus only on the person in that room.
   • As we wash our hands for 2 minutes, we can practice loving kindness toward ourselves or others, offer gratitude, or just think happy thoughts!

2. Replenish yourself, especially with the foundational needs of food, water, sleep, and exercise. Ensure physical balance and optimal health through proper food and exercise so that you avoid getting too hungry, angry, lonely or tired. Those four words form the acronym HALT. I know that when I am not intentional about attending to these conditions, I do not show up at my best. Taking a break (to halt) should not be perceived as a sign of weakness, because our self-care is vital. Make time for yourself. You know what relaxes you. Give yourself permission to do something relaxing, even if it's only for 60 seconds. Taking a break replenishes the mental and emotional energy associated with working hard and thus improves work performance and boosts energy.

3. Reset your own expectations and those of others. Be intentional to practice self-compassion and offer others the benefit of the doubt. Communicate by asking questions—and follow-up questions if you still are not clear about expectations.

4. Reflect. A few times a week, reflect for yourself in your journal or with others in a group.

   • Consider three questions: What gave me hope? What inspired me? What surprised me? This helps us reconnect our passion to purpose and reclaim our meaning in our work, which is a vital form of self-care.
   • Reflect on three good things and offer gratitude, which helps with mental, emotional, and spiritual replenishing. If you are journaling, imagine you are responding kindly to a friend with your reflections.
   • Journaling can help you reframe your self-talk; think positive and happy thoughts; and remember that it is okay to be sad, angry, or frustrated. That it is what makes us human.
   • Focus on the things in your control, and let others be accountable for what falls within their role. That's why we have teams.

5. Respect and be kind to yourself. Be intentional to practice self-compassion. Prioritize your well-being by speaking to someone when overwhelming feelings persist. Make self-care an intentional part of your commitment to yourself, your colleagues, and your vocation.

6. Relate. Be intentional to connect and reconnect with your community either virtually or in person, depending on which is possible. Relationships with our family, friends, patients, and colleagues teach us to cope and thrive despite adversities and vulnerabilities. A community of kindred spirits is vital to help us see the meaning of our experiences.

7. Resonate with your patients. I have come to realize that the most important question for us, both as physicians and as individuals is, “Why?” Each patient we touch has a why. We need to explore the why of our patient's story, because their why resonates with our story. As we listen to their why with empathy, we will begin to understand what brings them to see us—not just in terms of their physical ailment but as human beings. We will learn what provides our patients with meaning, hope, strength, and resilience and what matters to them. It will help us provide them with the holistic care they deserve. We will be able to assemble the pieces of the jigsaw puzzle that we explore with them and paint a beautiful picture that they want for their healing. We will be taught life lessons not found in any medicine text. We will understand how their story resonates with and enriches our own story. Explore your own why—your own story.

8. Reconnect with your why. Why did you answer the call to medicine—to commit to this vocation? Stories matter, and yours is unique. As such, collect them, reflect on them, and share them. Stories can hold magic, power, and sacredness. Stories are the seeds of who we are, who we are to become, and where we belong. Our why and our stories sustain us with meaning and strength! Stories can return us to vigor, perseverance, passion, and commitment, helping you heal when you are struggling through difficult times.

The question is not whether we have resilience but instead how we develop it; how we identify it; and how we are able to invoke, evoke, and promote it when needed. Resilience is not a constant; it is a lifelong journey to wholeness and well-being.

Back to the July 2020 issue of ACP IMpact