Physician understand thyself, and develop your resilience
Authors: Diann Eley, David Wilkinson, C Robert Cloninger
Publication date: 18 Apr 2013
Diann Eley and colleagues look at the key personality traits that increase doctors’ resilience and help them cope with challenges in medicine
Although resilience is helpful in all professions, it is particularly useful in medicine because of the demanding workloads that doctors face and their exposure to suffering, death, and uncertainty. Doctors constantly need to respond to challenges in their practice, and resilient individuals are better equipped to meet these challenges, learn from them, and develop their resilience. 
When attempting to identify those who may struggle to cope with life’s challenges, research suggests that looking at personality traits is more reliable than assessing single measures of resilience or stress.    In the world of medicine, assessments of general practitioners showed strong correlations between personality traits and resilience. Four personality traits in particular have a strong influence on one’s capacity for resilience: self directedness, cooperativeness, harm avoidance, and persistence.
Self directedness is evident in people who are conscientious, resourceful, and goal oriented, and it is the personality trait that has the strongest correlation with resilience. Busy people sometimes lose sight of their responsibilities and blame others when things go wrong; highly self directed people, however, accept responsibility for their mistakes, learn from them, and move on.
People who are cooperative are often more resilient because they accept the opinions and behaviours of colleagues, even if these are contrary to their own. They don’t lose sight of their own principles but work out solutions to achieve the best outcome for everyone. In contrast, low cooperativeness might indicate poor communication skills and a lack of empathy. Consciously becoming more tolerant and accepting the behaviours and points of view of others could lower your level of frustration and so help to eliminate a source of stress.
Harm avoidance reflects a tendency towards anxiety and pessimism in anticipation of problems. Clinicians who are low in harm avoidance are decisive and less anxious. Their ability to accept uncertainty and a degree of risk generates confidence for decision making in medical dilemmas and emergencies and is an important factor in making them resilient.
A tendency towards harm avoidance can be moderated by identifying the cues that trigger anxiety. Trainees who are uncomfortable in uncertain situations could seek supervision to work outside their comfort zone. Successfully overcoming fear of taking a risk, such as in decision making, may increase your confidence and help you manage uncertainty in future situations.
Persistence reflects a bias towards maintaining behaviour with stamina despite frustration, fatigue, or discouragement. It therefore plays a pivotal part in a resilient personality, although high persistence can also be associated with perfectionism, which can lead to burnout or depression. Persistence can be increased by sticking with a task until it is completely resolved, accepting mistakes, and consciously reflecting on what you have learnt from them. You can avoid the risks of perfectionism and other pitfalls of being overly persistent by identifying and accepting your limitations, learning from failures, and setting realistic goals for yourself and others.
To enhance your resilience, you should know which personality traits are linked to high resilience and be aware of your own trait pattern. Approaches to developing awareness of one’s personality are often embraced by medical schools, but even busy clinicians can improve awareness of their own personality traits.
Reflecting on the realities of your working life is a good way to start becoming more self aware. Are your expectations of yourself and others realistic? Are you constantly annoyed by the work behaviours of others? Do you have very high standards and expectations? You must ensure you match your high expectations to reality. Reflect on why you are so often dissatisfied. It may be that you are not as cooperative or tolerant as you could be. Once aware of your individual pattern of traits, developing or modifying these traits through exercises can help reduce your vulnerability to stress and dissatisfaction.
There are several simple exercises that can help to achieve this. Choose one and try to make it a routine part of your daily life. One is to recognise the positive outcomes of your day, however small they seem: re-analyse a situation that caused you annoyance or dissatisfaction and think about what you can gain from it. Another is to try to take control over some part of your day and allow for “time-outs,” no matter how short, over which you have control. A third exercise you can try is to share an experience or problem with colleagues, friends, or family. Often just talking about a challenging event can be a powerful way to put your situation in perspective, learn from it, and move on.
Overall, a positive attitude towards work will, in turn, promote positive experiences with colleagues and patients. For busy practising clinicians, adopting simple self awareness exercises may in time become automatic and result in a more resilient personality.
Competing interests: We have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.
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Diann Eley research coordinator for bachelor of medicine and bachelor of surgery programme
University of Queensland, Brisbane, Queensland, Australia
David Wilkinson head and dean of school of medicine University of Queensland, Brisbane, Queensland, Australia
C Robert Cloninger director Centre for Psychobiology of Personality, Washington University, St Louis, MI, USA