Physicians Anonymous

5 steps towards post-traumatic growth for physicians

5 steps towards physician post-traumatic growth

I wrote about Kintsugi, the Japanese art of using lacquer and powdered gold or liquid silver to repair cracked or broken pottery, in a previous post. I loved the idea of something broken being reworked and rebuilt into something more valuable. That’s the idea behind post-traumatic growth. In this article, I write about 5 steps towards physician post-traumatic growth. These are simple daily practices that may help you rebuild with precious metal holding and enhancing your imperfections.

What is post-traumatic growth?

Richard G. Tedeschi and Lawrence Calhoun were the proponents of Post-Traumatic Growth (1995). Their ‘functional-descriptive model’ of Post-Traumatic Growth described the growth as an outcome of active coping and indicated how it could change our worldviews and life goals. According to the originators’ revised model of Post-Traumatic Growth, the emotional distress that follows a painful encounter can be more empowering than self-debilitating.

5 practices for enhancing Post-Traumatic Growth

Post-traumatic growth comes in different ways – at times as evolving self-understanding and acceptance, and at others as selfless help to others.

Here are some daily practices for physician post-traumatic growth that I and others have found helpful during medical life:

One example of post-traumatic growth in medicine is where we realize just how fortunate we are. We are fortunate that, bluntly, we are not patients in the system.

1. Gratitude

One example of post-traumatic growth in medicine is where we realize just how fortunate we are. We are fortunate that, bluntly, we are not patients in the system.

Of course, many patients can and get better, and modern medicine is a marvel to behold. Nevertheless, as levels of chronic disease and longevity rise, it seems that suffering is on the increase, too. Moreover, with the cost of medicine outstripping resources, patients are bound to lose out, despite our best efforts, care, extra hours, blood, sweat and tears.

As a psychiatrist, I dreaded developing a chronic psychotic disorder or substance abuse issue (despite developing an addiction in later life – which I write about elsewhere). Faced with the prospect of a dread disease, I started to appreciate what was good in my life and important to me.

2. Appreciating loss

As physicians, we are surrounded by loss: of sight, limbs, functioning, cognition, cardiac function, life. We see our patients experience loss and we witness the impact on their loved ones. There is hardly have time to break bad news before our pager goes to the next cardiac arrest/surgery/Cesarean section/huge lung mass on CT that the patient who has never smoked had no idea about 2 hours ago.

While we physicians can and do have our own losses, we can also appreciate what we haven’t lost.  I guess this is a form of gratitude practice.

Moreover, loss can also force a change. For example, if we have experienced a significant loss, there may be opportunities in the new space made available. Green shoots can grow in open forest after a forest fire (and some species require forest fires as part of their life cycles). Through loss, it is possible to become more independent, change tack, and even grow in new directions through unexpected and perhaps unwanted new circumstances.

I am closer to some people than ever before. And my false friends are no longer taking up my energy. Like others experiencing post-traumatic growth, I can now recognize a palpable increase in relatability in myself.

3. Relationships and relatability

When my addiction came to light, I found that many “close” friends and colleagues dropped me like I was hot. In contrast, the minority who stayed with me – many of whom were unexpected – are without doubt my truest friends who know me at my most vulnerable and flawed, and yet still choose to love me.

Moreover, in turn, my openness has made it easier for them to share vulnerability with me. Both sides put more effort into the smaller number of relationships.  I am closer to some people than ever before. And my false friends are no longer taking up my energy. Like others experiencing post-traumatic growth, I can now recognize a palpable increase in relatability in myself.

Studies by Tedeschi and Calhoun showed that people who go through personal growth after trauma are more empathetic and can relate to others’ struggles significantly better than they did before.

Physicians experiencing post-traumatic growth undergo a significant improvement in interpersonal relationships, including friends, family, and work associates.

By focusing on others as fellow passengers on the bus of life and understanding that we are all flawed and trying to survive in the best way we know, we start to improve our connections with others.

4. New possibilities and opportunities

When trauma rocks our world, the walls may come down, but the roof opens up. Suddenly, we can see a whole lot clearer. We can experience enhanced self-perception and self-acceptance. In addition, we may develop a sense of thriving and heightened self-motivation.

Post-traumatic growth may manifest itself through:

  • Changed life priorities
  • New interests and hobbies
  • Recognizing more opportunities
  • A new or different life path.
I took up watercolor painting. Became a coach and consultant. Travelled. Intentionally spent time with my family to create memories.

5. Realizing personal strength

When faced with my rock bottom, my lowest low, and my biggest losses, it was medicine — ironically — that saved me.

I remembered my years in the trauma unit, the AIDS wards, the acute psych wards. The sleep deprivation, the violent patients, and their families. Crazy times, which I both loved and hated.

I recalled that back then, I did not think I would survive – but I did. Not only that, I went on to become a specialist and enjoy a career that helped so many people. I had relationships, finished a research doctorate, got published, became a parent, bought a house.

I reasoned that I must have at least some personal strength, and enough grit to get through experiences that only a handful of people go through.

I reasoned that I must have at least some personal strength, and enough grit to get through experiences that only a handful of people go through.

Doctors who survive the trauma of modern medicine and then undergo physician post-traumatic growth may start to realize the importance of self-dependence. 

In addition, they may learn to live on their terms, and grow an enhanced self-perception and self-acceptance (Meichenbaum, 2014). In turn, post-traumatic growth shields us against self-destructive thoughts and behaviors. We may experience a marked alteration in the philosophy and meaning of life, with more resilience to future stressors.

Furthermore, my personal experience of physician post-traumatic growth manifested itself in:

  • A greater appreciation for the value of my own life
  • A more incredible feeling of self-reliance
  • Knowledge that I can handle difficulties
  • I discovered that I’m stronger than I thought I was
  • I moved from victim to survivor

Action points

How do I utilize the principles of post-traumatic growth in my daily life as a recovering physician?

  • I write a daily gratitude list: a minimum of 6 things I am grateful for. It can range from a warm bed to having both my legs, to a good meal with friends. Time with my family features most in my gratitude journal. I write it every night and review it every morning as I get up. That way I go to sleep with an attitude of gratitude and am reminded every morning of how fortunate I am.
  • I start the day with meditation, reading, and exercise, focusing on my relationships, new opportunities,
  • I also journal a daily reflection at night: what went well, how could I have done better, what will I change tomorrow.
  • I make a point of connecting with others in a genuine, gentle, compassionate manner. This is through my 12-step fellowship, other support groups, and Physicians Anonymous forums and groups.
  • I recall the challenges that I have overcome and reaffirm that I have the personal strength to overcome the inevitable future ones.

Conclusion

In this article, we explored 5 approaches to enhance physician post-traumatic growth. 

These included gratitude, appreciating loss, relationships, new opportunities, and realizing personal strength.