Even when we are not in the midst of a global pandemic, clinicians face great stress in the workplace. Attending to and attempting to mitigate the tragedies of others, usually while navigating inadequate funding and resources, can take its toll on physicians’ wellbeing and mental health. With the ongoing covid-19 pandemic, many healthcare systems are under severe strain. The psychological challenges of the pandemic will have long term consequences for our healthcare workforce, who are experiencing a collective trauma that may well be with them for the rest of their lives. Doctors will need support from their hospitals and the healthcare systems they work in to help them navigate and cope with these challenges. But are there also strategies clinicians can deploy to increase their wellbeing?
As a social psychologist and professor in medical education, I work with students and practitioners to develop wellbeing and resilience skills. Research on resilience finds that how we appraise adversity—that is, how we interpret it and explain it to ourselves—has a big impact on our psychological outcomes. This does not mean it is OK to put someone into a toxic culture or untenable circumstances and then, when they struggle, blame them for not having the right happy thoughts. But we can all look back on difficult days during the pandemic that felt worse because of how we thought about our situation and difficult days that we made better because of our thinking. These thoughts are levers we can pull to help ourselves and others when times are tough.
Adversity can be viewed as a threat when we focus on potential damage or harm, or as a challenge when we focus on opportunity and growth. Research shows that the lens we adopt is typically a function of our resources and demands. When demands outpace resources, we tend to be in threat mode. When resources outpace demands, we tend to be in challenge mode. Resources and demands may be concrete: no one would blame a clinician for being in threat mode if their team has insufficient personal protective equipment (PPE). But our sense of resources and demands has a psychological aspect as well.
You can increase your sense of resources by thinking of other difficult situations you have successfully worked through and remind yourself of these past successes. Where possible, conceptualise the pandemic as a challenge, a struggle that will eventually be won, and think about the skills and abilities you have already developed through this experience and will continue to build upon moving forward.
To reduce demands, break them into pieces: focus on what needs to be done over the next hour or by the end of your shift. By focusing on one small portion of a big demand we can step from threat to challenge mode.
Research shows that social support is one of the most critical factors in having a resilient response to adversity. By getting support from others we increase our resources, and by sharing a burden we can reduce demands.
Due to the unprecedented pressures of working in a pandemic, the demands of working in healthcare at present will still be overwhelming at times. A technique to improve wellbeing is the “what went well” exercise, which has been repeatedly demonstrated in randomised controlled trials to have a lasting, positive impact on wellbeing.  At the end of each day, think of three things that went well that day, and why. You can do this on your own, or with your clinical team at the end of a shift. Not only will this get you into the habit of looking for and noticing positives, which is a key component of wellbeing, but it will also help your team learn about what enables accomplishment.
When I think of a positive that might come out of this pandemic, I focus on our slow, but real progress towards making clinician wellbeing a priority. Of late, there has been a much needed movement to change the culture and structures of clinical settings both to enhance wellbeing and to destigmatise psychological distress among healthcare practitioners. The pandemic has exposed for all to see the absolute necessity of having a healthy and well functioning healthcare workforce. Let us all hope our current struggles will accelerate progress towards a clinical environment that promotes physician wellbeing and greater care for one another.
Jill Klein, Professor, Melbourne Medical School (Department of Medical Education) and Melbourne Business School, University of Melbourne.
Competing interests: none declared.
1] Seligman ME, Steen TA, Park N, Peterson C. Positive psychology progress: empirical validation of interventions. American Psychologist 2005;60(5), 410.