Showing vulnerability is not a failure—doctors could learn from Biles’ example, says Clara Munro

On Wednesday 28 July, US gymnast and Olympian, Simone Biles made the decision to pull out of the woman’s all-round gymnastics final at the Tokyo Olympics citing the need to “protect her mental health.” While the decision was met with a great deal of praise at her bravery, a not insignificant minority were vocal in accusing the 24-year old of being selfish and “letting her country down.” What strikes me is that Simone’s decision is not only noteworthy for the bravery it required for her to step back from what was expected, but also from the lessons we can all learn about how it is “ok to not be ok.” What can we learn about how to step back when you are not doing your best for yourself or your team? How can we sit more comfortably with not doing what is expected and shouldering the burden of perceived failure?  

Accepting imperfection is hard and something that, like athletes, doctors are famously bad at. The vast majority of us struggle hugely with the concept of failure and relinquishing control. We are self-selected, usually as teenagers, as over-achievers with ambition, most with the noble mission of “helping people.” We are then cultivated in a medical school environment that is a fertile ground for competition, pitting us against one another, creating a partisan world of winners and losers. Vulnerability is not framed as courageous, but as a failure: admitting we cannot do something, or we are not up to it sets us back against our peers, so we are encouraged to get our heads down and be better, plastering over these cracks with rehearsed confidence that is too easily equated to competence.

This method may have relative success in producing a cohort of individuals who can draw the brachial plexus on demand and recite side effects of peculiar antiquated medications, but it significantly limits us from being “good doctors”—to our patients, to our colleagues, but arguably most importantly, to ourselves. When faced with the inevitable failure that doctoring brings, we are all too often woefully unprepared for the emotional fall out this brings, and the realisation that we are flawed, imperfect humans who will make mistakes. 

Simone Biles is not a team-mate who ducked out of the “race” early. She won national competitions with broken toes in both feet, won a world championship with a kidney stone, and spoke up about the sexual abuse that she faced at the hands of Larry Nassar, The USA gymnastics team physician. She has shown great courage and mental strength and we should absolutely respect that she knows when enough is enough. There is no textbook that can teach any of us when this time is, but if we know we are not safe to perform, whether it’s because we have the “twisties” or are unable to make safe clinical decisions, it is time to step back. This is not failure, this is leadership. 

Leadership has become a buzz word, a box to be ticked on an application form, or a course to attend in order to progress to the next stage in your career. What leadership is really about is knowing when to push on and when to step back. By doing so, you can set an example to those who “follow” you and have the humility to know what you can do and what you can’t. Knowing your limitations is not a weakness, it is strength, both in a sport where you could sustain a physical injury and in a job where the effect of your decision making can mean the difference between the life and death of another human.  

While we talk endlessly about leadership, we do not give enough time to what it means to follow, and a huge part of this involves knowing how to support our leaders or our team members to make these hard decisions. We need to be better at trusting when those who lead us, or work alongside us, hold up their hands and say they have reached their limit. When a doctor has the courage to say—“I can’t do this right now, I am not doing the best for myself or my patients, I need some time,” we need to be better at saying, “it’s ok, take the time you need”—just like Simone’s teammates publicly said to her–not branding them a “let down” or “weak.” If we are to place individuals in high-stress, high-stakes performance-based roles, such as those of athletes or doctors (to name just two), we need to be far better at fostering an environment that gives those individuals the opportunities to say they are not ok. 

Brene Brown, a US researcher, defines vulnerability as the “unstable feeling we get when we step out of our comfort zone or do something that forces us to loosen control.” For so many doctors paradoxically our comfort zone is the 2am trip to theatre, running a cardiac arrest, dealing with road traffic accident trauma calls. Our comfort zone is keeping on keeping on. Stepping out of the zone involves accepting imperfection, and it is this control that we struggle to relinquish. The ability to be comfortable with inevitable failure, the notion of our own imperfection and admitting vulnerability is a skill we are not taught early or well enough at medical school, but it is essential to maintaining the balance between the job that we do and retaining our own mental wellbeing. There will be times when the balance tips and knowing, as Biles did, when you are no longer doing the best for yourself, your team or—in our case—our patients, and to step back is something that we do not see enough. True leadership is not about knowing when to step forward, but knowing when to step back. 

Clara Munro, editorial registrar and clinical fellow, The BMJ, and general surgical trainee, North East England.

Competing interests: None declared.