Three other philosophers and I recently devoted eight hours of Socratic Dialogue to the topic of resilience. Using this method, participants blend philosophical inquiry with personal experience in a search for truth. Our goal was to define resilience, not from somewhere “outside” ourselves (i.e., from books, teachings, etc.), but from within, based solely on the lived experience of one of the participants. 

Our “dialogue” differed from a “discussion” in that we spent our time investigating (rather than convincing), listening to ourselves and each other (rather than taking positions), and questioning (rather than answering) in order to come up with a definition that might apply to virtually all persons regardless of circumstances (before starting, we chose to focus solely on modern humans/Homo sapiens).

Our collective inquiry concluded that resilience is the manifestation of positive adaptation resulting in personal growth in an adverse situation. To this, we added the stipulation that resilience is a process that implies decision making (a cognitive means by which one chooses to believe, act, or feel from among possible alternatives) and flexibility of mind (the ability to adapt one’s thoughts, emotions, and behaviors to changing situations).

I have since been thinking about how this definition applies to health care providers. Medicine is an emotionally and cognitively demanding profession. Sometimes it is also physically exhausting. There are strenuous work schedules, long hours, ethical dilemmas, and pressures from working with scientific uncertainty. There are legal considerations, the burdens of teamwork and an occasional forced collegiality, as well as the reality of medical and surgical errors. Workplace-related political traumas, bureaucratic overload, interprofessional drama, and the burdens of complex decision-making are not easily overcome. With the addition of repeated exposures to human suffering and loss, particularly in the absence of adequate support from family, friends, colleagues, or institutions, a health care provider’s emotional, mental, and psychological states are prone to dysfunctionality. 

Burnout, for example, touches almost half of all physicians in the United States. This affects patient outcomes, institutional efficiency, professional longevity, and overall well-being. Several studies show that physicians are at greater risk of burnout (characterized by symptoms of distress and dissociation) and have lower satisfaction with work-life integration than the general population, after controlling for age, sex, relationship status, and hours worked per week.

Resilience, manifested as positive adaptation in the face of significant adversity, is more than showing grit or being emotionally “tough.” According to our group’s definition, it is also a potentially life-changing or “perspective-altering” phenomenon closely linked to personal growth and self-awareness. It is, therefore, both intrapersonal and relational. It allows health care providers to engage deeply with patients and those around them without being consumed by adverse situations. It supports cognitive clarity under pressure and demonstrates the ability to experience distress without becoming dysfunctional, while maintaining the capacity to reframe adverse situations in ways that engender positive feelings, actions, and thoughts.

• Van Rossem K. What is a Socratic dialogue? Filosofie Jrg 2006;16(1)48-51.
• Luthar SS, Cichetti D, and Becker B. The construct of resilience: A critical evaluation and guidelines for future work. Child Development 2000;71 (3):543-562.
• Panagioti M, Panagopoulou E, Bower P, et al. Controlled interventions to reduce burnout in physicians:
• a systematic review and meta-analysis. JAMA Intern Med. 2017;177(2):195-205. doi:10.1001/jamainternmed.
• West CP, Liselotte ND, Sinsky C et al. Resilience and burnout among physicians and the general US population. JAMA Network Open 2020;3(7):ee209385. doi:10.1001/jamanetworkopen.2020.9385.