Strategies For Resilience In the Time Of COVID-19

Closing The Gap Blog – March 2020

As an executive coach for physicians, I work with many colleagues who are in a state of overwhelm. Sometimes this overwhelm is intrinsic to their lives – the result of some stressor like a divorce, a sick child, or a lawsuit. Other times this overwhelm is external – the result of circumstances beyond anyone’s control, like COVID-19 and the incredible challenges we are now facing in our workplace.

Regardless of the source, this sense of overwhelm must be addressed quickly. It is an emergency. If we ignore this feeling and keep pushing forward one step after another while keeping our heads down, our minds or our bodies will eventually fail us. I think we all recognize that we have a long haul ahead of us, and if we are to endure we need strategies for resilience and vitality.

These are the three key strategies that I have found in my work to be powerful for physicians to help them get on top of their overwhelm – regardless of its source – and find a way to move forward that is more sustainable.

Strategy #1 – Giving ourselves permission to be “just good enough” and focus on the essential.

It is likely that your stressors and demands have exponentially grown over the last few weeks. Our work was hard enough as physicians to begin with. But now we are dealing with a whole new set of challenges: the level of risk in our workplace is higher, we have to do our jobs in overwhelmed environments that are under-resourced, and then we have to go home and keep those around us healthy. Add to that a spouse whose job is threatened, or having to homeschool our children, and you have the perfect storm. It is no wonder we are panicked, trying to find new solutions and new ways to get more done.

But we have to be careful about our tendency to problem solve. Under tremendous stress like we are experiencing now, most people engage in escape mechanisms. For some this is may be food, drink, or social media. But for many physicians, their escape mechanism is responsibility. When things get tough, we tend to escape into taking more responsibility for the people and things around us. We paradoxically feel the need to step up and be the problem solvers because that is the role we are used to. It is how we deal with our anxiety and fear.

But in times of extremis, taking on more responsibility and finding more solutions and more ways to get things done is not the solution. The problems are too big, many don’t have solutions, and it is not possible to come close to getting it all done. Working harder will not work. It will only burn us out faster.

Instead, we need to do what goes against every fiber of our being and focus on doing less. We need to give ourselves permission to not solve every problem and to be less than perfect. We need to take it day-by-day, and focus on only what is essential for life today:

You went to work and did what you could while staying safe? Check.

You ate food and took a shower? Check.

Your kids are in bed and they still have ten fingers and ten toes? Check.

To give ourselves permission to do less is an act of grace and self-compassion. We have spent so long thinking that scoring 89% is a failure that it is incredibly hard for most of us to reduce our efforts in any way, in any part of our life. But saying “no” or “not right now” is not a sign of weakness. Rather it is a critical skill for taming the immediate overwhelm, so that we can recharge and endure for the long run.

So ask yourself, where can you let things slide? Where can you say no to (self-)criticisms? Where can you give up feeling not-good-enough? Where are you taking on more out of guilt and compulsion when you should be focusing on doing less?

Strategy #2 – Dropping Anchor

It is only in the present moment that we can take meaningful action. That may sound obvious when we say it out loud, but how often are we in our heads either ruminating about something in the past or anticipating something in the future? The truth is, we spend an inordinate amount of time responding to that which is not in front of us right now, especially when we are facing crisis. 

For physicians dealing with practicing during COVID-19, this often manifests as thinking about all the balls that we are dropping at home while we are at work, and then spending our time at home ruminating about what did not go well at work, or how bad our next work day might be. In doing so, we compound our stress and miss the opportunities to take valued action that are right in front of us.

In addition to strategy #1 above, an incredibly simple and powerful tool to combat this is “dropping anchor.” Many physicians I work with have found tremendous value in using this technique a few times throughout the day. You can do it anywhere – between patient rooms, for a few minutes in the bathroom, or when you find yourself inside your head ignoring your kids or significant other. 

To start, take a moment to pause and really feel the ground beneath your feet. Take a few breaths bringing your focus to the act of breathing itself. Then take a moment to notice five things that you can see around you right now. Try to notice things you wouldn’t otherwise. The crack in the ceiling tile, the color of trim of the hospital ward that you never registered before. 

Once you have noticed five things that you can see, listen for three or four things you can hear. Again, trying to notice what you were too busy to notice. The hum of the air vent. Distant footsteps. Perhaps even notice what you are not hearing in that moment.

Next, move on to feel. This can be the ground beneath you. The lab coat touching your skin. The flow of air around you. The temperature.  After noticing that you are noticing each of these, move on to try and find one or two things you can smell.  Register those. And last, notice what you taste. Is it this morning’s coffee, or nothing at all (which is still something to notice)?

Most physicians are very skeptical of this exercise until they actually do it while at work. It has the effect of bringing you in contact with the present moment, the only place you can really take meaningful, valued action. It calms the discursive chatter in your head and allows you to focus your energy here, now. Like an anchor on a ship, this exercise does not make the storm go away, but it does provide a steadiness. 

Strategy #3 – Live your choices and remember your Why

Under stress we all have a tendency to focus on fear and anxiety. Our day-to-day becomes motivated by a desire to avoid, reduce, eliminate, or mitigate the negativity we feel. This is natural and a consequence of how our minds work evolutionarily and how we have evolved to prioritize emotional comfort.

The problem with this is that when the discomforts are existential and unavoidable (like COVID-19 and all its consequences) our natural tendency to agonize over the downsides of our choices only amplifies our distress. We need an alternative strategy, and that is to instead spend more time embracing our choices, focusing on what we value, and acknowledging how what we are choosing to do on a daily basis is in alignment with who we wish to be.

To make this concrete let me give you some examples. I have had many physicians tell me in the last few weeks that they would quit immediately if they did not have to keep a roof over their heads, or feed their children, or support their parents. I also have clients who have quit or taken leave, because they now have to take care of their children full time, and they feel an incredible sense of guilt or inadequacy in having done so.

Like so many of us, these physicians face impossible dilemmas, and it is easy to spend all of our cognitive energy wrestling with the fear and anxiety behind wondering if we are making the right choices.

But we can approach these dilemmas differently. First, we have to remember that in a true dilemma there are no great choices (otherwise there would be no dilemma!). Fixating on right and wrong is a fool’s errand.

Second, we need to acknowledge that we have to choose. It is impossible not to. Every day you wake up and go to work, you are making a choice. When you tell your employer you can no longer work, you are making a choice.

Instead of agonizing over whether that choice is “right,” we can simply acknowledge that we have made that choice today. When we do this, we can then pivot to asking ourselves what we want to stand for in the next 24 hours given that choice. What values are we living by making this choice? How does it help us to support who and what is important to us? Since I am making this choice, how do I want to care and contribute?

It really comes down to a choice between focusing on controlling our discomfort versus committing to our values despite the impossibility of the situation before us. Neither choice makes our problems go away. The dilemmas are still there. The crisis has not abated. But when we embrace our choices and focus on the values behind them, we do create more resilience and vitality.

These three strategies – giving ourselves permission to be good enough and do less, dropping anchor, and living our choices – are the three most effective strategies I have found for overwhelmed physicians. Respectively, they are about reducing demands, increasing control in the present moment, and increasing support through self-compassion and pivoting to values. In using these strategies, we give ourselves a little bit more resilience and make the quality of our days a little better, something we can all use in these unprecedented times.