Chapter 27: Crisis management – how to cope when the chips are down
|"One often learns more from ten days of agony than from ten years of contentment."
- Merle Shain.
Doctors are trained to treat medical emergencies such as a cardiac arrest, intraoperative bleeding, or an asthmatic in acute respiratory distress, which means they are used to handling a crisis . These are life-or-death crises, and doctors are expected to retain their cool and remain unflappable, because their presence of mind can spell the difference between life and death for their patient.
However, these are crises which affect other people – your patients ! Handling a crisis in your personal life is often a completely different cup of tea, and many doctors go to pieces when faced by a personal crisis. The truth is that all of us face crises in our lives – but thankfully, not too often ! A personal crisis is as old as mankind , and divorce, financial loss, being sued for malpractise, illness and bereavement are some of the things in your life that can bring you to crisis point.
By the law of averages, it’s simply a matter of time till you are hit by your first crisis. The older you grow, the greater the chances of facing a crisis – and the sooner you learn to cope with them, the better ! This is why self-made individuals who have come up from scratch often end up doing so much better than others in life. They have faced many crises in their life before, and have successful dealt with them. Each crisis you handle makes you stronger, and more capable of handling the next crisis as well ! It’s also much easier to learn from other’s problems , which is why it’s such a good idea to help others ( juniors and colleagues) to cope with their crises. Your objective advise can help them deal with their problems– and will also teach you what to do when you face similar problems in your own life !
Adversity is the best teacher , and a crisis can teach you a lot about life and how to live – the key question is - how well can you learn ? Accept that the crisis will change you – hopefully for the better ! Living through a crisis can be hell – but you need to learn to maintain your equanimity . Don’t take out your anger and rage on your employees, patients, colleagues, friends or children. Trust your inner strength – you have been through worse, and you can weather this storm as well ! There are certain personal qualities will help you cope better and these include: self-confidence; optimism; a sense of humor; resilience; and faith in God. ( Interestingly, playing games such as chess or tennis will help you deal better with a real life crisis when it hits. Being 0-5 down in a tennis match or facing a check is a crisis of sorts, and dealing successfully with this mini-crisis will help you deal with the bigger real-life crises , when these arise.)
Unfortunately, when faced with a crisis, many doctors start feeling sorry for themselves; start blaming others for their predicament; or waste energy looking for a scapegoat. You need to move beyond self-blame – don’t react like a victim. When a marriage crumbles, a job is lost, a loved one dies or a child suffers a debilitating illness, people tend to blame themselves-"If only I had worked harder," or "If only I had taken better care of him." None of us gets through life without some mistakes. You may share some of the responsibility for the crisis, or, more likely, it would have happened no matter what you did. Either way, the important thing is what you do with the rest of your life. When recovering from a life crisis, self-blame is a luxury you cant afford. This is pointless and an exercise in futility - it’s better to deal with the crisis and move on !
You may believe it is impossible for you to recover from this hard time; and sometimes a second crisis comes and sets you back before you recover from the first crisis. Everyone has their own level of being able to cope before they reach their breaking point. High adrenaline levels will help you manage the initial crisis; but persistently elevated levels can be counterproductive ! You may find that the stress of coping will start affecting other parts of your life such as your concentration, sleep, appetite and sexual life. You will find your feelings swinging wildly from hope ( that the crisis will blow over) to fear ( that the worst will come to pass) , and this can affect your mental and physical health. The crisis needs to be acknowledged and dealt with - you need a chance to adjust and start the healing. Please reach out for help –you will soon find out who your real friends are in your time of need !
Don’t let what you are going through embitter you. For example, one of the commonest crises a doctor will face is being sued for malpractise. Many doctors become cynical and disillusioned once they have been sued, and start treating all patients as potential adversaries. Don’t let one isolated incident jaundice your view on life – you need to bounce back and move on !
It’s interesting that the Chinese expression for "crisis” consists of two characters - one means "danger” and the other "opportunity.” Every crisis carries its own blessing with it – but often only the passage of time and a lot of maturity will allow you to find the good side in this mess. People seldom tap into their deepest strengths and abilities until forced to do so by a major crisis. Living through a crisis will definitely make you more empathetic towards other people who also find themselves in a crisis – such as your patients. Many doctors find they are much more sympathetic towards their patients when they have faced a critical illness themselves !
One of the best ways of learning how to cope with a crisis is from our patients . Compared to most of our personal crises, our patients go through much worse situations, such as the loss of a child, life threatening illnesses, and imminent death. Many will deal with such a crisis with such grace and wisdom, that they are living lessons for all of us. Their attitude can be a source of inspiration and courage for you.
It’s important to keep your perspective – be objective. You will have to accept that life is not always fair, and that "bad things do happen to good people” because " we live in an imperfect world." A sense of humour can be invaluable at this time ! No personal crisis ever marks the end of the world, even if it seems to do so at that time. Don’t magnify the problem or start imagining that it is unmanageable. Also you need to learn to be detached - don’t take it personally. Many people have been through worse, and have survived their baptism by fire , and so can you ! Keep your self-esteem intact – this will help you to bounce back. Learn to accept reality, no matter how bitter it may be, because the sooner you do this, the easier it is to deal with it. As Rudyard Kipling advises so wisely and eloquently in his poem, If, " If you can meet with Triumph and Disaster, And treat those two impostors just the same”.
Research has shown that when faced with the same crisis, some people will crumble; other will survive; while others will thrive. These are the hallmarks of the survivors .
Reason : Survivors focus on problem-solving their crisis. They control their emotions; set aside panic and think logically during a crisis, especially about the true nature of the crisis and realistic options for solving it. They always have a Plan B, in case things don’t work out as expected.
Focus : Survivors are 100 percent present in the moment. Thinking too much about past experiences or future possibilities distracts from survival.
Integration : Survivors must be emotionally healthy enough to integrate their tragedy and its consequences into being one part of their larger life story.
Positivity: After a crisis, you will never be the same again. Making lemonade from lemons is crucial after a crisis. The key challenge is, how can you make something positive of this? How can you come out of this a better person?
While some crises can blow over quickly, others can be a long drawn out and painful process. Not only does it eat into your time, it also saps your energy and monopolizes your attention. It also extracts a huge emotional toll, and many doctors when faced with a crisis go through a process of five classic phases of grieving, as first described by Elizabeth Kubler-Ross when talking about dying patients. The first response is one of Denial: I am a fine doctor and a good human being ; this cant be happening to me! The next stage is one of Anger: Why should this be happening to me when I am such a good person? Doctors will often vent their anger on family-members, their staff, and even other patients. The next stage is one of Bargaining, where the doctor pleads with God to, let him off the hook this time, and promises never to err again! This is followed by Depression. Many doctors start doubting their competence and professional ability, and wonder if they should just stop practicing medicine altogether. The final stage is one of Acceptance, when the doctor comes to terms with the fact that dealing with a crisis is simply a fact of life everyone has to face up to; that it is not a reflection on his personal worth, and learns to get on with his life! Being prepared for the emotional havoc which going through a crisis can play with your life can help you to cope better: dont try to minimize the impact it has on you and your feelings by pretending its of no consequence!
It’s usually a good idea to continue working, if you can do so. Your patients can be a source of strength , and if you find satisfaction in taking good care of them, this will help to bolster your self-esteem and confidence ! Hiding and running away from the problem will often compound it.
It’s a good idea to prepare for those crises which you can. Some are predictable, and you need to manage these proactively. For most doctors today, it’s simply a matter of time till a patient sues you for alleged malpractise. Taking out a professional indemnity insurance policy and knowing what to do when you are sued will help you retain control. Be prepared – have a plan, and then follow it.
A key part of handling a crisis is damage control, and there is often a lot you can do to prevent the matter from becoming worse. It is natural to feel like a helpless victim after a devastating crisis, but you cant recover from grief until you overcome these feelings. In the midst of your sorrow, make a plan to take charge of your life. While you may not be able to solve the whole problem or wish it away, remember that no matter how much of our life we think we cannot change, there is always that part that is within our control, and that we can work on – be it 2 percent, 5 percent, or whatever - it is always more than we suppose !
Going through a crisis often serves as a wake-up call, which forces you to look at the "big picture” and where you are heading in life. Treat this crisis as an educational lesson – it may prove to be an expensive lesson, but you need to learn it ! Many of us get so desensitized by the daily monotony of life, that we often lose our ideals and goals. A crisis will help you focus on the purpose and meaning of your life; so that it can actually serve as an opportunity for personal and professional growth. Life is full of ups and downs, but the sad reality is that we all learn much more from the downs !