How to build resilience in uncertain times

April 27, 2020

In this Joule COVID-19 Learning Series webinar, host Dr. Jillian Horton speaks with Dr. Ron Epstein, a family physician, researcher and teacher of mindful practice in medicine at the University of Rochester.

Dr. Epstein shares his research on why adopting a mindful practice can help physicians manage stress and build resilience in times of uncertainty.

tweetable: “I'm a palliative care doctor and frequently deal with situations where there's tremendous conflict within families or between families and clinicians. It's so tempting to want to shut that conflict down and to try to resolve things quickly. But, if you slow down, listen and don't act quite as fast, often things resolve themselves more easily.”

KEY TAKEAWAYS

What is mindfulness and why does it matter to physicians now?

  • In difficult situations, some people think it is easier to “turn off” their feelings, but Dr. Epstein says our feelings eventually catch up to us and direct our behavior or reactions in unexpected ways.
  • Mindfulness is a conscious and purposeful way of turning towards those experiences, examining them, and using them to direct us to act in the best interest of our patients and ourselves. It can help us be deliberate, rather than reactive.
  • With COVID-19, we're in what Dr. Epstein calls epistemic uncertainty: a time where tremendous uncertainty has upended our usual rules and boundaries.
  • Trying to work through this level of uncertainty with problem-solving will only get us so far. We also need to apply open-mindedness and curiosity.

tweetable: “At a certain point, we have to recognize there’s going to be some uncertainty we just can't get rid of ― so in my view, a healthy reaction to that epistemic uncertainty is curiosity. And it's only with a certain kind of openness that you can begin to see, appreciate and act on those observations.”

Can you talk about the evidence for using mindfulness in high-stress medical environments?

  • There is some evidence that when you train teams performing CPR to be more mindful, you get better outcomes. The team’s communication also improves. People can stop and pause before reacting and focus collectively on what’s most important.
  • There is good evidence for mindfulness in high-stress environments outside of medicine ― the military is known to use mindfulness to preventing irrational behaviour in the face of extreme distress. Teams, units and individuals are trained to be able to stop, take a breath, assess a situation and achieve a certain degree of focus, attentiveness and calm before proceeding.

tweetable: “There's so much you can’t control in those situations, but you can control your response and reaction. And if that response is to be more present, to be calmer, to be more available, to begin to see the novelty of that situation… then your day will have been better than it would have been otherwise.”

Resilience is a word that can make some physicians and medical learners bristle because it's perceived as an accusation or a weakness. What is your definition of the word and why shouldn't we resist working to increase our resilience?

Intrinsically, physicians are very resilient. But, Dr. Epstein says there's a difference between short-term and long-term resilience:

  • Physicians tend to do well with short-term resilience, which he defines as getting through an acute crisis.
  • Their long-term resilience is of greater concern, because the stressors wear you down over a longer period.

Embedded in the idea of long-term resilience is the need to grow from our experiences. Growth in mindfulness includes learning to:

  • Harness our attention
  • Increase our curiosity
  • Apply a beginner's mind
  • Be present

There are many ways to be present:

  • Create a sense of virtual presence: Make a point of connecting with a friend or colleague. It doesn't have to be an hour-long zoom session; it can be a two-line text.
  • Invest 30 seconds to listen: At the beginning of every encounter with a patient, ask them what’s going on and take time to listen.
  • Take brief pauses during your day: Once you’ve finished with a patient, take two or three seconds to reflect on that encounter so you can be present, listen and best serve the needs of the next person.
  • Never worry alone: When you're feeling afraid, seek connection with yourself and others.

tweetable: “[When I’m entering the room to see my next patient], I habitually touch the doorknob, take a breath and mentally set aside what's just happened. I don't suppress it ― I know it's there. And with that breath, I feel a sense of openness.”

How can we improve our active listening skills during virtual encounters?

Virtual presence is usually more powerful with people you already know and can make those connections stronger. When you're speaking with those you don't know well or don’t see often, there are a few tricks:

  • Keep it interactive: Talk for 30 seconds to a minute and leave space for others to speak, so that people aren’t tempted to tune out.  
  • Make eye contact: If you’ve chosen a video format, make eye contact with the camera periodically to increase the sense of connection.
  • Know your saturation point: Our tolerance for virtual connections seems to be shorter than in-person ― consider shorter meetings with some breathing time in between.

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This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule.  Feel passionate about this topic? Please connect with us at jouleinquiries@cma.ca.

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