Is Resilience Enough?

With our Resilience special edition having recently hit your doorsteps and some great chat on Twitter this week, I thought it would be useful to look at what we all mean by this very well used term of ‘Resilience’ because it seems to mean different things to different people – but can everyone be right?

Perhaps they can.
The figure below is from an article in BJGP ‘Resilience: what is it, why do we need it, and can it help us?’, a co-author of this being our amazing InnovAiT editor Chantal Simon. It shows the different types or layers of resilience and this, to me, seems to cover the differing perspectives well.
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The area discussed most in our special edition was the first layer – Individual Resilience. The more we, as individuals, are resilient the more we can avoid feeling stressed from at least the smaller daily challenges we face.
On a good day I can recognise that there is an inefficiency in the system or that someone else has done something a bit rubbish without feeling too frustrated. But I know that when I am feeling more worn down, tired, and with a series of such things, I feel irritated and this edge to my mood is hard to shake off. For those GPs and surgeries who are on the brink right here, right now, some small changes may allow them to be supported in order to keep going and actually remain open.
On Twitter there was concern that we are being told to toughen up and get on with it when actually all around us is increasingly difficult. I agree, there is no way that the individual resilience is a sufficient sticking plaster alone to do this, nor should we be expected to make it so.
If the environment in which we are working is dysfunctional, no amount of coaching will be enough. We need to ensure that the places we work are more supportive, (Organisational Resilience), that we engage with the public in a positive way to gain their support and push for the political solutions too – so perhaps instead of #resourcesnotjustresilience the push for resources is in fact the third layer of resilience as a whole.
As discussed in the very frank article in the BJGP, we need public and political support to redress the chronic starvation of funding to primary care and increasing tide of unresourced work that we all face day in and day out. Pushing to do this as one voice would undoubtedly give us the most strength.
I would love to hear what you think – agree or disagree. I am thrilled to hear that the special edition is being taken into VTS sessions for heated discussions – just as it should be!
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All Work and No Play

I thought I sort of understood fibromyalgia. Well, as much as was realistic to for a condition which has no diagnostic test, no definite clinical progression and that many people are not even convinced has a pathophysiological cause. But then I met a young patient who did not have a diagnosis of any sort and looked on the surface as being very well. However, she was increasingly disabled with pain, her mood becoming lower as well as having persistent abdominal symptoms. When it was my place to broach the subject of Fibromyalgia it suddenly all felt a lot less clear in my mind. Dr Rachel Imrie’s article which is now available OnlineFirst, gives a brilliant summary of the condition and what our current understanding is and discusses the vital ways in which a GP can offer support.

If you haven’t already read it in the OnlineFirst, June’s issue is filled with all of the brilliant resilience and burnout articles I talked about in last week’s blog, as well as a truly moving article written by Dr Chris Manning. He talks very openly about his own experiences and questions the history of medicine alongside current understanding as to how we now find ourselves so vulnerable.

One of my favourite quotes this month is ‘Sustained stress makes us more dull-witted and unfriendly’ – which I read as an evidence based, high brow version of ‘All work and no play makes the GP dull and grumpy’. I have heard or read many discussions amongst GPs as to how best ‘switch off’ from work and we always have a prepared answer for interviews as to how we recognise and manage stress in ourselves but how often do we actually put it into practice? I think I managed it a little better when I first finished medical school, but now with all the other life factors (for me, mainly children) it is genuinely hard to find the time. I have taken some nuggets from these fantastic articles to implement, especially to ‘Take Back Control‘, I hope you can find some which work for you too. Let me know @rcgp_innovait
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Do you?

Do you document verbal consent for every intimate examination? Including breast examinations?
Do you use written consent for joint injections?
Do you know what IMCAs, LPAs, DOLs are?
If you would like to read more about these, this article on consent and capacity brings together the latest BMA and GMC guidance and is a great easy option to remind yourself. These areas impact on everyday work we do, such as death certification, so it is worth being up to date. (It is also currently available online for free if you’re not already a subscriber to InnovAiT!)
A potentially difficult area to discuss with a trainer is that of stress and burnout. Trainers usually want to inspire and guide, not dwell on negativity. However, it is increasingly recognised as an essential part of our training – we need to look after ourselves in order to be able to help the patients. Of course there is the fantastic podcast on Resilience, but also already available on Online First, is ‘Burnout in general practice’. Dr Peter Davies discusses the causes of burnout and what help is available.
Following on from this, the article by Dr Clare Gerada and Ellie Blame talks of how to remain mentally healthy despite our often natural tendency to ‘plough on regardless’. It makes sense that we are more likely to make mistakes if we are tired or distracted so it is essential for us to recognise difficulties for ourselves and our colleagues. Also available OnlineFirst is an article analysing the pilot course held recently REFRAME:Resilience training for GPs. Importantly, it discusses where resilience training sits in the bigger picture of the NHS. Is it just the latest buzzword or pragmatic way to prevent burnout?
On another note, we have just had the council and mayoral elections but it is now time to vote for the RCGP council members. You can read about the candidates here and then you just need the passwords from your emails to vote. Only takes a couple of minutes but make sure you have your say before the end of May as to who should represent your views.
Remember InnovAiT access is free to all AiTs and a great option for finding out more and  for eportfolio evidence. If you are unsure how to access it, click here to subscribe – and don’t forget to sign up for this blog to be emailed directly to you! If you don’t already, you can also follow us @rcgp_innovait.
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REFRAME: Resilience training for GPs

REFRAME is a half-day resilience workshop, originally developed for Foundation doctors, and refocused for General Practitioners. This mixed methods pilot study evaluated whether resilience training is acceptable to NHS GPs and relevant to the problems that concern them. Fifteen participants attended and most were looking for information to help them manage their working life and avoid burnout. The qualitative data provided powerful positive feedback suggesting that participants found the practical information, and the act of setting aside time to share problems with peers, of value. Understanding the neurobiology of stress provided important personal insights and illuminated vital areas for potential self-management with the majority motivated to make simple but potentially effective changes to their lifestyle and working environment thus enabling them to become more resilient. Participants indicated that they would value access to online resources.  REFRAME, as a brief resilience training module, has been accredited by the RCGP.  Further development through focus groups of both content and course evaluation is under way.

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