Resilience is the ability to bounce back after being psychologically stressed or challenged. It perhaps has never been more imperative that physicians and medical organizations commit to promoting resilience within their profession. Survey research suggests that between 30% and 50% of physicians experience anxiety, sleeplessness, or depression in reaction to personal problems, and the relative percentage of physicians who report dissatisfaction has grown considerably over the past decade.
And this dissatisfaction may be "contagious". In The Resilient Physician: Effective Emotional Management for Doctors and Medical Organizations, we point out that a broad-based literature has demonstrated that cross-correlations exist between the following variables:
o Measures of physician health
o Physician happiness
o Staff morale
o Retention of key employees
o Marriage and family satisfaction
o Patient satisfaction with medical care
o Patient adherence
o Incidence of malpractice claims

Keys to Resilience
We have long known that many factors converge to promote resilience, including the following: a sense of humor, higher levels of intelligence, belief in god, prayer, and participation in an organized faith community.
But the most powerful predictor of resilience is the very variable most at risk for physicians today: maintaining caring connection with others. In a recent survey, physicians rated conflicts with the people they work with, supervise, and report to as being the most stressful aspect of their professional life. And conflict over work/family balance has been cited redundantly as a primary stressor for physicians, especially for those under 45 years of age.
We offer the following strategies for shaping resilient physicians, medical organizations, and medical families.

o Evaluate yourself.
You cannot expect your relationships to feel any better than you do. Unfortunately, physicians tend to be better at self-denial than self-care. For example, physicians frequently have no general practitioner of their own. Rather, many self-medicate, and respond to their own illnesses by continuing to work. Physicians also report higher levels of sleep deprivation and fatigue than are found in the general population, and they suffer for it.

o Do sweat the small stuff.
Fortunately, little changes can make big differences in promoting resilience. Don't forget the basics:
-Even if you do not have time to formally "exercise," take advantage of any opportunity to engage in physical activity throughout the day. Even these little bouts of exercise can boost your parasympathetic calming reactions and dampen your sympathetic arousal.

-Eat healthily. Eating nutrient-rich meals and snacks 5-6 times each day has been shown to improve work efficiency, energy , metabolism, and mood.

-Regularly take "recess." Having endured so many years of hard work, many physicians forget how to relax and play -- an important, rejuvenating part of life that you deserve to experience guilt-free. In our experience, difficulty with self-nurturing is the culprit that leads many physicians to pseudo-nurture with substance abuse.
A key to overcoming this pattern is to accept that here, as in any realm of life, the change process goes as follows: Attitudinal or conceptual clarity --> (leads to) Repeated bouts of behavioral practice --> (leads to) Emotional comfort.
Put another way, comfort with play or healthy self-nurturing does not come naturally; you have to practice engaging in healthy pleasures until doing so becomes comfortable. You must also bear through the awkwardness that at first comes when you begin taking better care of yourself or your relationships. Remind yourself that this feeling does not signal "I'm faking it;" it means "I'm practicing something worth learning how to do well."

o Become a physician leader.
Collaboration and collegiality in medical organizations are by-products of the behaviors of medical leaders. Team-building efforts take time, skill, and those who spearhead such efforts may find themselves in a relatively thankless position; some even become scapegoats for colleagues' discontents. Your leadership efforts are more likely to pay off if you follow a few simple guidelines.
-Hold regular, focused meetings that include all principals in your organization.
-During times of organizational change, be sure to get full commitment to the plan,
communicate a unified purpose, and promote understanding of the change process
-Openly and evenly share information with your partners.
-Work to include all of your group in decision-making processes.

-Do not participate in gossip or coalitions within your group.
-Openly praise and express appreciation to each of your physician partners
- Speak positively about the work of the people in your group and of your organization as a whole.
-Speak in terms of Awe@ rather than creating Aus-and-them@ distinctions.
-Beware of the Teamwork Killers that follow:
Silence Brevity and abruptness
Ignoring Discrediting
Blaming Secretive decision making
Mixed messages Passive/Aggression
Snubbing Aggression
Insults Discounting
Outbursts Lack of response to input
Cool/aloof behavior

o Give up the myth of the balanced life
In The Medical Marriage: Sustaining Healthy Relationships for Physicians and Their
Famlies, we argued that virtually no one perfectly balances work, family, and personal needs. A more realistic approach to sustaining work/family satisfaction incorporates the following:
-Accept that it's okay to love your work. The real risk is "waiting-until" for a lifetime.
-Never turn a monthly calendar without blocking out a 12-to-48 hour period that you designate as "relationship time."
-Each day, find time to have multiple, brief, nurturing interactions with people who matter to you, even if doing so involves regularly taking only 20-second breaks to make contact. Try doing this for a total of 10 minutes every day.
-Learn to say no. Remember that every time you agree to do something, you are agreeing to give up some of your personal and family time.

-Schedule unplanned days. We recommend that you and your partner set aside at least one day each month that is proclaimed an unplanned day. Such experiences will teach you to enjoy meandering - one of the best ways to rejuvenate otherwise exhausted friendship, communication, and romance.
-Take many, mini-vacations. When it comes to personal and relationship health, taking multiple, brief vacations each year is far more effective than "saving up" to take only a few, lengthy breaks.

-Honor each other. Avoid two classic mistakes made by troubled medical marriages:
-The typically absent physician-husband criticizes his wife's childrearing tactics
-The non-physician spouse criticizes the physician's long work hours.
In happy medical marriages, each partner openly honors and expresses admiration for the contributions made by the other partner.

o Be generous and be gracious.
In The Medical Marriage we observed that physicians and their families often remind us of modern-day heroes. Here we are not referring to those who perform extraordinary acts. Rather, we define a hero as someone who creates safe spaces for other people. How? With acts of generosity and graciousness. Both at work and at home, the best way to promote resilience is clear: Be Generous and Be Gracious. No message we know of can better insure stress-hardiness. Generously offer to other people the kind of attention, support, conversation, and respect that they need in order to feel safe in your presence. And graciously respond to such "gifts" offered to you by others. In so doing, you will become a source of resilience for each other.

*This article originally appeared in Missouri MD.

Wayne and Mary Sotile speak internationally on physician collegiality and medical family life. They have authored seven books, including The Medical Marriage (AMA, 2000) and The Resilient Physician (AMA, 2001). Contact the Sotiles at 1396 Old Mill Circle, Winston-Salem, North Carolina 27103. Phone: 336-794-0230 . E-mail: wsotile@attglobal.net. Visit their web cite at: www.Sotile.com.