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Resilience in the NHS.

The global movement to redefine resilience.

The NHS refers to resilience in various forms but never as a parameter for success. Resilience is used as adjectives, nouns and verbs, such as 'being resilient', 'is resilient', and 'builds resilience'. These are ways to describe the doctor in the art of doing and working in the NHS. I would like to consider resilience as a state of being. In the NHS, building a resilient workforce is one strategy for suicide prevention, as part of creating mentally tough people. All of the above is all true, valid and fit for purpose, depending on what that value means to the beholder (this can be the doctor or the organization), but I’m learning through reflection, that it is not the act or art of being resilient that matters the most when faced with adversity. It is being able to survive whatever crappy situation that lands on your table, and this does not come from accumulating an accolade of words to describe being resilient.

In 2022, an article by Dr. Lorna Breen, an ED doctor said “stop telling physicians to be resilient”. It rang a bell for me because resilience was been preached like doctors need to grow more liver to face their tough job. It was one of the skills, like communication that we needed to master. The language and tone around 'preaching resilience' needed to change. Doctors had had an earful about building resilience. I stopped seeing resilience as a skill or an act that I must tow to keep in line with NHS. Being a doctor is enough resilience on its own, and I needed to own that and celebrate that.

Resilience should be one of your success metrics, but not in the way you think.

I’ll be unable to count the many lemons life has dealt me in the last few years of living and working in the NHS. It spans from demotivating corridor feedback to written complaints to racist interjections or verbal exchange on the ward, to COVID infection, repeated stressful exams and ARCPs, sorting social conundrums to manage work-life balance or even the stress of completing my first coroner’s report last year. It sometimes felt like the longer I stayed in the UK and serviced the GMC license, the further I climbed, and I harder I fell. Setbacks are not uncommon in life. Being able to walk away from these situations is why I see resilience as a success metric. What tactical intervention, reasoning, support, course etc I used in surviving these situations are tools for surviving. As long as I walked away and was still able to stand and face what tomorrow brings. That's my true measure of resilience.

Resilience should not, is not about the strong-head, strong-willed mindset that we are taught to practice. It is about honours, awards or being the G.O.A.T. It is not a set of affirmations and CBT training for the mind when adversities continue to threaten our existence and continue to peel at the very core of our being. That to me, is an illusion of strength. I have learnt that when faced with adversities, resilience is my ability to delve into my arsenal of social connections, skills and knowledge, to extract the optimal resources needed to weather any storm. This may be using your network of social connections and community to find the help and advice that is needed. This can be leaning on your credit score to open doors to finances to help in emergency situations. This can be about being supported by friends and family through challenging times. This can be banking on your years of hard work and diligence to show the coroners' office that one unexplained incident is not a case of professional negligence. The wealth of back-ups and safety nets are work-related the lifeline that empowers resilience and equips us as IMGs with the necessary tools to not only survive but thrive amidst adversity.

Resilience is akin to being a master magician, skillfully reaching into my bottomless hat of tricks, conjuring the much needed resource to navigate through life's tempestuous storms.

This is why I agree with Dr Lorna Breen and other campaigns to change the practice of describing resilience as a skill. As an IMG, resilience is my ability to walk away from social and work-related issues (sometimes with a few bruises) after deploying several strategies to alleviate the risks and stress involved. It is my ability to not just survive the storms or volcanic eruptions, but thrive and grow afterwards in the soil rich in experience and knowledge. My ability to achieve professional and personal growth in the NHS and UK is not only about 'building resilience as a skill' or declaring positive affirmation, it is about building an amory or reserve of social networks, financial capabilities, goodwill and various resources to fortify one's self to weather any tempestuous storm.

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