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Resiliency in Medicine: "Bounce-backness" Is Crucial

Ann L. Contrucci, MD

August 25, 2022

What is resiliency? How do we as physicians teach it to our patients? To our medical students and residents? To our colleagues? To ourselves?

When I am talking to patients and families who have gone through struggles, tragedies, or are even just navigating the messiness of life, and I discuss resiliency with them, two words always come to mind: Bounce. Back. When I mentor a medical student struggling in his or her preclinical years (ahhh yes, good times, those first 2 years of medical school…NOT!), two words: Bounce. Back. When I have comforted a colleague who just lost a patient, two words: Bounce. Back. When I went through a 2-week malpractice trial from hell and was eviscerated daily for "incompetence," despite a unanimous verdict in my favor, two words gave me strength to continue in my career: Bounce. Back.

So how do we define this "bounce-backness"? And more importantly, how do we get it, keep it, and teach it as physicians?

There are many academic definitions of resilience including various aspects related to psychology, social constructs, and ethics. In my career as a pediatrician and as a member of clinical faculty teaching medical students and residents, I find that it boils down to this: thriving despite and because of adversity.

So many students arrive to medical school with the grades, the MCAT scores, the extracurricular activities, "all the things" except certain elusive features: the resiliency, the grit. I still remember my first day of medical school (which was a loooooong time ago!) and hardly being able to contain my excitement of my lifelong dream becoming a reality. Then. Reality. Hit. Medical school was so much harder than I even imagined. What did I get myself into? I mean, I had the grades, I had the MCAT scores, I had the extracurricular activities, "all the things," right? I remember calling my dad and saying I couldn't do it and wanted to quit, I would never be a doctor, I wasn't smart enough. He would go "tough love" on me and remind me that I had wanted it since I was 5 years old and I wasn't a quitter.

Let's put it like this — we had that conversation more than once my first year of medical school! And I was haunted not only by imposter syndrome but also by the echoes of former teachers/professors telling me in high school and college that I would never be able to go to medical school and succeed, my math and science aptitude just wasn't "good enough." Blah, blah, blah.

Fast forward to third year of medical school, and, finally, to clinical rotations — the fun stuff! And then watching my first patient die, not knowing if I had the emotional strength to "do" medicine. But then — Bounce. Back.

Fast-forward to residency: my dream of becoming a pediatrician now real life! Giving the diagnosis of cancer to a 4-year-old's family for the first time. Being up for 36 hours and still needing to complete rounds and take care of my patients. Doing helicopter transport as a resident and thinking on my feet with critically ill children. The stress seemed insurmountable at times. But always — Bounce. Back.

Then, finally an attending physician in both private practice and a children's hospital emergency department, as well as teaching medical students and residents. Countless tragedies, countless happy moments, countless proud moments making a difference in another human's life.

Resiliency is not a moral judgement related to a person's character. Resiliency is not a supernatural power. It is, however, synonymous with perseverance, adaptability, recovering successfully from failure, humility, to name a few. It is realizing that we all must show vulnerability and ask for help at times. It is finding the people who "get you." It is being confident that you will succeed and that it may take a while. It is a sense of self, what your strengths and weaknesses are, the things that make you, YOU. It is having the ability to work with others (aka "plays well with others"). It is taking care of your own physical and emotional health — realizing that it is nobody's responsibility but your own. It is the motivation to actively participate in your community with empathy and meaningful contributions. It is the capacity to turn traumatic helplessness into learned hopefulness.

When I speak of resiliency, make no mistake: I am not speaking of "toughness" to the point of sacrificing our physical/emotional/mental health and well-being. That extreme is not healthy behavior. However, I do believe that there is a very fine line of mental and emotional toughness and perseverance that seems to be disappearing in medicine. Instead, I see entitlement and lack of accountability.

I circle back around to the question: Are we born with resiliency/bounce-backness? Can we develop it, and if so, when? Early childhood? Teen years? Adulthood? Can we grow it? Can we teach it? And the answer is, a resounding YES. To all of the above.

I have come to the conclusion that not only is resiliency crucial during times of adversity, but it exists because of adversity. Out of ashes, a phoenix rises. Resiliency is the phoenix. We do what we gotta do. As physicians, we Bounce. Back.

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About Dr Ann Contrucci
Ann L. Contrucci, MD, is a board-certified pediatrician with almost 30 years' clinical experience. She has practiced rural and suburban primary care as well as urban and suburban pediatric emergency medicine throughout her career. She also had her own solo practice in Ontario, Canada. She is currently an Assistant Professor of Pediatrics in the Clinical Education Department at Philadelphia College of Osteopathic Medicine. Her particular areas of expertise and passion include mental and emotional health issues in children and adolescents, in particular anxiety, emotional dysregulation, and eating disorders.

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