“Between stimulus and response, there is space. In that space is our power to choose our response. In our response lies our growth and our freedom.”
– Viktor Frankl
In the post-pandemic practice environment, the autonomy-squishing “big ask” within many organizations is for providers to see more patients and improve practice efficiency with dwindling resources so as to buffer the bottom line and allow for system recovery. This mandate may make us feel hopeless and without a choice in the matter. Before COVID-19, fixing broken bodies and offering care to the suffering was already demanding service-oriented work that often went unrecognized. Now, under further time and energy crunch, we objectify one another to simply get the work done. Less personal bandwidth means less connection, flexibility, compassion, and, as data reveals, more burnout.
Why does the current circumstance create a feeling of hopelessness? This big ask is a trigger to our already fatigued sympathetic nervous systems that can lead to despair that life will never get better. The fight, flight, freeze, withdraw response is knit into our very being and is definitely activated when we feel overworked and our livelihood threatened. Those who tend to flee or withdraw under extreme stress are part of the Great Resignation. Some of us who feel frozen in place will continue on as automatons within the broken health care system, and others who are more wired to fight are pushing back in both resourceful and non-resourceful ways. I often witness all of these responses in myself and my colleagues each day as this mandate is being walked out within my institution. For some, the shift from fight, flight, freeze and withdraw happens almost hourly.
From an organizational standpoint, the realities of financial and access challenges are real, and a solution is required. This fact cannot be ignored. Strategic discussion is around leveraging resources and technology and ensuring the right work is done by the right people. In the trenches, we may still have the viewpoint that what we are being asked to do is a painful personal accommodation that greatly infringes on our autonomy. What does a shift in perspective look like to consider exploring strategies with openness, flexibility, and creativity? This might require us to shift from being willful to willing. When we are willful, we are inflexible and a bit stubborn. Think for a moment of a strong-willed child you have met. Maybe it is one of your own children, a family member, or a neighbor kid. The kiddo prefers to make their own decisions and figure things out for themselves. They don’t follow the step-by-step instructions for the craft project because they have their own ideas for how things should be done. How frustrating, as an adult, when we try to guide these children. Yet they also have wonderful redeeming qualities of innovation, creativity, and strong leadership skills.
Many of us in medicine have this combination of attributes, and we have a choice as to which of them we might use at any moment in time. Medical training leads us to prefer autonomy over subordination. In training, we are inundated with rankings and comparisons and pressure to perform exceptionally well to achieve top grades and not be shown by our colleagues. Vulnerability and anything short of perfection are considered failures. Being willing is about accepting our vulnerabilities and choosing sufficient rather than perfect outcomes.
Willingness also comes when we choose open-mindedness, flexibility, and creativity. As humans, we already do hard things every day. In fact, we have chosen to do hard things as a career, so taking the path of greater resistance is not unfamiliar territory. Adding in a patient or two or releasing some control over our schedules so as to accommodate a few more patients is toning up our toughness. From a neuroscience standpoint doing hard things also promotes neuroplasticity. In other words, flexibility begets flexibility. Is this a perspective you can embrace? One comeback might be, “What do you think I have been doing for the past 2 1/2 years?” Yup, I’m right there with you, and at this moment in time, we can still choose to move forward in a resourceful way.
Choice is always available.
Your sacrifices and responses to the unprecedented challenge of the pandemic are admirable. Can you choose to honor that which is in the past and choose post-traumatic recovery to meet the needs of a new health care world? This both/and thinking promotes creative tension, which may lead us to some of our best solutions. You might say that I’m a pollyanna trying to view the cup half full when it is more than half empty. The intention here is to remind us we always have choices. We did not choose the dilemma, but we have choice in how we respond to it. Some choices may seem more challenging depending on whether we chose a narrow or wide perspective, a non-resourceful or resourceful perspective, or a willful or willing perspective. No chastisement here because we are in the same boat, and I guess we all want to keep it afloat. We are imaginative, innovative creatures who have amazing skills and the ability to make change. Consider the big ask as a request to harness and share our multitude of skills while we continue to do the hard things we do every day, and because we always have choices and we still have hope.