Revisiting Resilience – The Practice of “Presilience”
"How we respond to the issue is the issue." – Linda Graham, LFT, psychotherapist, author, and resilience expert
Oh no! Not another blog about resilience! The word itself often triggers mixed reactions in physicians, ranging from defensiveness (“Quit blaming me and fix the system!”) to resignation (“I’ll just survive until retirement”). But a recent Medscape article reminded me of a critical balance: while the healthcare system must be held accountable, we clinicians must also focus on keeping “our own house in order.” Let me explain.
When I first engaged in leadership around clinician well-being, there was a common frustration that too much emphasis was being placed on making physicians more resilient, as if that were the sole solution to addressing clinician burnout and distress rather than placing the focus on fixing a broken system. It was compared to blaming the canary for not surviving the coal mine or the toast for getting burned in a broken toaster. Physicians, as the argument went, were already among the most resilient individuals—our journey through training and practice demanded it. So shifting the focus to physician resilience and away from organizational and systemic dysfunction was perhaps expedient, but dishonest ... and wrong.
However, over time I’ve realized this perspective was only part of the truth, and therefore incomplete. It assumed resilience – the ability to “bounce back” from adversity, was an enduring quality; that once you had it, you always will. The truth is, resilience requires continuous cultivation, much like physical fitness or clinical skills. Neglecting it can leave us unprepared for the inevitable challenges of our profession.
In her book Resilience: Powerful Practices for Bouncing Back from Disappointment, Difficulty, and Even Disaster, Linda Graham describes resilience as “response flexibility” and our ability to adapt depends on personal resources (emotional, cognitive, physical), external support systems, and the nature of the stress itself. Resilience isn’t just about “bouncing back” but ensuring we’re regularly preparing ourselves to better face those challenges so we don’t get “bounced” so hard in the first place – or what I have come to call “presilience.”
How about you? Where could your resilience muscles use strengthening? Reflect on recent challenges: how well did you use your internal and external resources? Where might you improve? Next week, I’ll provide some additional reflections and resources, but in the meantime, remember that even if you’re doing well (or even “fine”), cultivating “presilience” ensures a greater readiness for future stressors. And don’t forget that “your” resilience is best practiced as a “team sport.” One more reason to check in with your PeerRx partner this week, as if you needed one. Afterall, no one should care alone. Now’s a good time to make sure you don’t think you’re the exception ….