President's Word

Becoming strong in our broken places

by Susan Abbey, MD, FRCPC
CPA President

Feeling tired out and somewhat disgruntled by a day that wasn’t going my way (urgent patients needing to be shoe-horned in, yet another impossibly gray Toronto winter day, and a mountain of disability insurance paper work that wasn’t going to get done given the growing line-up outside my office), I headed off to the hospital Tim Horton’s for a caffeine boost.

Instead, to my good fortune, I ran into a classmate from medical school, Dr. Barbara Stubbs, who is now a family physician. We had one of those hallway conversations that helped much more than any extra-large double-double ever would.

I asked her what was keeping her going as she looked far too bright-eyed for a February day. She told me that she and her physician husband were part of a doctor’s book club and had been reading about physician resilience, and in the process were cultivating their own. We shared our enthusiasm for Rachel Remen’s Kitchen Table Wisdom – Stories That Heal. The stories come out of Remen’s experiences as a physician, therapist and patient. I told Barbara about the CPA’s own Dr. Mamta Gautam’s Irondoc: Practical Stress Management Tools for Physicians.

When I asked her what “new finds' her group had made, she directed me to Wayne and Mary Sotile’s The Resilient Physician: Effective Emotional Management for Doctors and Their Medical Organizations. It has become a new favourite and I wanted to share it with you as it offers something useful to every physician, either for their personal lives and relationships, or for their work lives.

The book is divided into two sections – one directed at physicians and how we live our own lives, and the second at understanding and managing relationships in the workplace. It is accessible, practical, and down to earth. The Sotiles understand the reality of physicians’ lives and offer a range of doable suggestions.

Their chapter on stress resilience begins with Ernest Hemingway’s quote from A Farewell to Arms: “The world breaks everyone. And afterward some are strong in the broken places." This immediately brought to mind Saki Santorelli’s Health Thy Self: Lessons on Mindfulness in Medicine, with chapters such as “Shattered But Still Whole" and “Discovering Radiance in the Ruins".

The challenge for all of us is how we process and work with the suffering we see on a daily basis and how to cultivate optimism and meaning in the face of work that brings us into contact with loss in its many forms – trauma, uncertainty, vulnerability, ambiguity, and unrelenting change.

There is a knowledge translation gap in translating newer knowledge about promoting and cultivating resilience just as there is in almost every area of knowledge and the Sotile’s book helps to move us into a 21st century understanding of how to better work with the stressors in our lives and rebalance ourselves after stressful events. Their approach is informed by the literature on physician mental health and their more than 20 years of clinical practice treating physicians and their families.

The book encourages us to cultivate value-based living and provides practical exercises and strategies to help time-pressured physicians clarify their values and current priorities. They describe the importance of having clear goals of how we would like to live our lives and what changes we need to make to promote greater resilience. Identifying and countering thinking patterns that perpetuate or aggravate our stress are a key component of managing our stress. Unhelpful cognitions that are cultivated in medical training are identified – “limitations in knowledge indicate a personal failing�?, “responsibility is to be borne alone by physicians�?, “altruistic devotion to work and denial of self is desirable", “it is ‘professional' to keep one’s uncertainties and emotions to oneself" – and countered in ways that are helpful to doctors.

Finally, we are challenged to make conscious choices to cultivate optimism at times when pessimism threatens to overwhelm us; and humour when hostility and cynicism beckons. By focusing on the daily uplifts or small spurts of pleasure that are available each day and incorporating small and healthy pleasures into our day-to-day life, we can buffer the stresses we face each day.

Most of us experience a sense of renewal with the arrival of spring. Given the upcoming long weekend (for those of us lucky enough to not be on call), I’d encourage you to spend a little time reflecting on what your priorities are for the coming spring and summer, and choose one action you can take to build your stress resilience.

Spring also brings the CPA Spring Round when volunteers from across the country meet in Ottawa to work on your behalf. You can trust we will be busy operationalizing our new mission statement and goals, which place a greater emphasis on the CPA acting to improve the quality of the working lives of Canadian psychiatrists.

© Copyright 2009. Canadian Psychiatry Aujourd’hui. All rights reserved.

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