Why Grit Alone Is Not Enough
Are you feeling drained and thinking that going through another day of work is not appealing at all? Have you been pushing yourself, persevering, succeeding, yet not having much fun? Are you wondering why, when you might have a seemingly successful career, a great family, and financial security as a physician, it feels like something is not quite right?
In a pre-pandemic survey conducted by the Canadian Medical Association, physicians were asked if they are resilient. The resounding response was “yes”. When those same physicians were asked “do you feel burned out?” they also answered “yes”. Can someone both be resilient AND end up burned out?
The answer is “no”. Well, sort of. It’s complicated. The CMA is doing valuable work by exploring the well-being of the physicians they support, and the survey results raise the possibility that perhaps clinicians may not all share the same definition of “resilience”. So, I’m going to do 3 things:
Review the definition of resilience
Say something that will probably make you mad. Really mad. You might be tempted to close the blog post when you read it – please don’t
Talk about how over-reliance on grit gets in the way of resilience
Defining Resilience
The concept of resilience is rooted in material science. A material is considered resilient if it is able to withstand impact and strain without fracturing and can maintain its original shape under a sustained load. As you can imagine, resilience is not an either-or proposition, but rather exists on a continuum – there are mathematical formulas that describe just how much stress and strain a material can withstand.
Psychologists borrowed that concept and applied it to humans (as psychologists are wont to do!). Psychological resilience, as defined in the APA Dictionary of Psychology, is:
“The process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioral flexibility and adjustment to external and internal demands.”
Based on the above, we can surmise that it is difficult to answer the question “are you resilient?” unless it is placed in the context of a specific situation or type of situation. It may be more useful to reframe the question as “do you feel you have the resilience to address x challenges or y stressors?”.
Here's where I make you mad.
The truth is, many doctors are not resilient enough to withstand the pressures of modern practice.
What?! Did I just call doctors weak?
Breathe...
Stay with me...
Resilience is a relative term – you are resilient against a stressor if your skills, reserves, and practices match or exceed the demands placed on you mentally and physically. If I said “most elite weightlifters are not strong enough to lift a 400-kilogram weight”, would you think I was calling weightlifters weak? Hopefully not – you might wonder what weight is more realistic to lift, and what training the athletes could do in order to feasibly lift that weight (for the record, only 6 of the men competing in the heaviest weight category at the Tokyo 2020 Olympics lifted more than 400 kg).
Extending the weight-lifting example to the healthcare system:
80% of burnout drivers are at the organization level. Organizations have a responsibility to take reasonable measures to reduce these drivers to a manageable level.
The remaining 20% of burnout causes are mediated by factors at an individual level. Physicians have the opportunity to train and evaluate their technique to better carry the weight of their profession.
When I say that clinicians aren’t resilient enough to withstand the pressures of modern practice, I am not calling them weak. I am not attacking or undermining their strength of character. I am, however, pointing out that there is a mismatch between the expectations of the system and what physicians are able to sustain. It saddens me that there seems to be a sense of shame in the medical community about feeling overwhelmed and increasingly burned out, and I think that shame gets in the way of asking for and offering real help. That, however, is a topic for another day.
In my work as a consultant to hospitals and professional organizations, I recommend changes to benefit their staff and create environments that are more supportive of the well-being of healthcare professionals.
In this Resilience blog series, however, I will write about specific strategies that individuals can use immediately to improve their ability to work more sustainably without burning the candle on both ends. Resilience is multi-faceted, having biological, psychological, and social components. And it is FASCINATING.
Despite t many factors contributing positively to resilience, in my practice I see many physicians relying on one single trait to get through difficult days (and there are a lot of them).
How over-reliance on grit gets in the way of developing and maintaining resilience
Grit is that “dig deep” function – it's what got you through all-nighters in med school and 36-hour shifts during residency. It usually involves ignoring some core needs (like rest, food, and social connection) in order to reach a goal.
Angela Duckworth, the author of “Grit: The Power of Passion and Perseverance”, defines grit as perseverance and a commitment to a superordinate goal despite setbacks and obstacles. If you are a physician, you quite likely have grit and used it to get into medical school, get through medical school, and now to continue in the field of medicine. Grit is not luck, self-compassion, talent or intelligence. It is necessary for success but it cannot by itself ensure that your effort can continue indefinitely.
Our work environment, with its complex gears, pressure, and culture can make one feel overworked, unappreciated, treated unfairly, isolated, and with no room for growth and fulfillment. When such things occur chronically that is when burnout sets in, a state of profound depletion. Not that you cannot work and study long-term, of course. Rather, what I mean here is that pure perseverance and commitment must be married to be a part of an overall strategy that makes it possible for you to thrive and feel fulfilled in the long-term.
If burnout is a state of depletion caused by excessive drains on your mental, physical, and psychological energy, resilience is in many ways the opposite state. Resilience is about being able to withstand a stressor or a challenging event and then bounce back to normal, undiminished by the experience or even to experience post-event growth. In practice, it is a state that is created by a combination of traits, circumstances, thought processes, and practices. There are biological, psychological, and social contributors to resilience. This might be made more clear with an example:
Situation: en-route to the airport, you receive a notification that your flight was canceled.
State 1: you have a great marriage, close supportive friends, good physical health and you slept well all week along with exercise and healthy meals.
State 2: you are tired from being on call 3 times this week, you experienced conflict at work and you missed lunch altogether, plus you just had another argument with your sister, and your wallet was stolen.
As I am sure you will guess, how you respond to the news of your canceled flight might be very different if you are experiencing state 1 or state 2. In the second state, you might begin to catastrophize, snap at staff on the ticketing counter, and maybe the rest of your day gets progressively worse. In State 1, you might initially feel surprised and frustrated but have the bandwidth to launch into problem-solving mode and even find yourself enjoying some camaraderie with fellow passengers as you commiserate about the travel industry.
Sure, maybe that is a simple, light-hearted example relative to what clinicians are facing today. But the take-home point is the same: the background state of your emotional and energy reserves determines both how you react to difficult situations and how easily you return to the resilience zone. If you would like to take a deep-dive to explore your own resilience makeup, you can access the Resilience Scale here. It is a comprehensive, valid and reliable assessment that provides a detailed explanation of your resilience score. If you take this assessment, you will see that resilience is multifaceted, further underlining the premise of this blog post which is that grit alone is not enough to be resilient to the stressors of medical practice and life in general.
As we continue with this blog series, my goal is to provide useful, validated information about how to enhance and sustain a state of resilience. Solving burnout is a complex endeavour. However, through a combination of plucking some low-hanging fruits right from the start and slowly and consistently updating practice structure, thought processes, self-care, communication with colleagues, and more, you can move the needle in a positive direction. Small, consistent changes can add up to noticeable, significant changes over time. I encourage you to stick with it, one step at a time, and invest in your resilience, so that you can be successful while also happy and healthy