In the Arena: Perseverance Is Contagious

baehrenDuring an academic discussion recently, a colleague said that to be a physician requires quite a bit of resilience. I nodded in agreement. He mentioned the fact that several hundred doctors commit suicide each year and wondered what makes some physicians resilient to the pressures of work and life and others not.

This is an interesting question to ponder because it goes to the root of who we are as individuals. To make it through college, medical school, and residency requires above-average resiliency. There are those, however, who after entering practice become disillusioned and depressed and cannot persevere.

Is the problem fatigue from having to repeatedly pick oneself up out of the mud, or is it the surprise of finding oneself in the mud at all? I believe that it is the latter. Everyone, to some degree, had the expectation that professional life would be grand once residency was completed.

There is no doubt that life is better after residency, but few can honestly say that no unwelcome surprises came along. It's the other guy who gets sued. I'm not the one who will be treated disrespectfully by a colleague. It's some other person, not nearly as smart as I am, who will get cheated in a business arrangement.

If I'm running an obstacle course and I see three out of four people ahead of me fail to clear a water jump, I won't be surprised if I'm all wet before I finish. But if I set an unrealistic goal of running the course without getting dirty, I'm sure to be disappointed and possibly disillusioned.

This is where the quality of perseverance comes in handy. Combined with a bit of street smarts or horse sense, perseverance can lead to many successes.

When I was a scoutmaster for our local Boy Scout troop, I spoke often of perseverance. I told the boys that intelligence, good looks, money, and connections will get you only so far. Sooner or later you are going to fall flat on your face and nobody is going to pick you up. The successful person is the one who falls down 9 times and gets up 10.

I'm concerned about our current generation of learners. Many have been raised in an atmosphere where false confidence is gained not through experiences of success and failure but through praise regardless of level of effort or degree of success. Many of these learners have never received a tough critical appraisal of their efforts, and when they do, they are surprised and hurt by the negative feedback.

I believe that people who are raised in an atmosphere where they are not allowed to fail are afraid to take risks or to venture outside of their comfort zone. These timid folks will not be the leaders of tomorrow. Helicopter parents who do their child's term paper and make regular trips to do laundry for their college student are not doing anybody any favors.

Part of growing up is learning how to fail and then how to carry on. A big part of learning in residency and medical school is to know how to take criticism for errors or for gaps in knowledge. The professor does not need to be overly stern, but at the same time needs to get the point across.

When a second-year resident can't identify an obvious fracture or wants to discharge an ill-appearing infant with a high fever, that resident needs to be corrected directly. "It's okay, honey, you'll do better next time" is for toddlers.

Learners who can't take legitimate, even-handed criticism will not fare well in the often hostile hospital environment. They need to learn to take their knocks in a sheltered environment before someone who cares little about their self-esteem whacks them over the head.

I'm not one who thinks that the work-hour restrictions are making all the residents soft. Being up for 24 hours straight is hard enough. All that being up for 36 hours straight did for me was to reinforce how much I hate sleep deprivation. The residents work hard, but hard work alone will not create resilient doctors.

Residents need firm and constructive criticism on a regular basis. This builds a strong mind and a thick hide. It also creates confident physicians who are humble enough to know that they don't know everything.

It is said that boundless energy is wasted on the young. I find that the longer I practice, the less I stumble. When I do stumble it seems to be easier to get up each year. I guess perseverance is wasted on us older docs.

Like energy and enthusiasm, perseverance is contagious. Share this quality with your younger colleagues. You may be the person who makes the difference between someone having a long and fruitful career and a short and frustrating one.

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