Sunday, April 24, 2011

Confronting Calamity

Adversity is defined as a condition marked by misfortune, calamity, or distress; an unfortunate event or circumstance. Potentially adverse events and circumstances come in all shapes and sizes, and how distressful they are is usually determined by our perception of them. If we believe that we have the ability to meet the challenge, or if the demand of the situation is not an important one, we aren't stressed. However, if we don't believe we have the skill or knowledge to manage the situation, but believe we must handle it well, we will feel stressed. In meeting daily challenges, our perceptions of which ones are important, and our assessment of our abilities and skills, determines whether we are facing adversity or just a situation that may be slighting annoying.

So what do we do when stressed, when we are faced with a situation that makes an important demand on us, one we are not sure we can meet? The general answer is we do what we have learned, what we have seen others do in a similar situation, or what we have done in the past. And being creatures of habit, if what we did in the past appeared to work, we will often try it in a new situation. Unfortunately, trying harder in the same way may not work. A new situation, even if it resembles one we've dealt with before, may require a new and different solution.

What can help us to be resilient, to bounce back during hard times? Certainly training and education about resilience skills and attitudes is key. Bay Path College in Massachusetts is a fine example. The college recently began offering a stress management course to students in its One-Day-A-Week Saturday Program, an accelerated, full-time degree program for women looking to earn an undergraduate degree. The women who enter the One-Day-A-Week Saturday Program are seeking to transform their professional and personal lives. Many of them have young children at home, work full-time jobs; a number of the women are working, single mothers, and so their stress level is high to begin with.

The course examines the concepts of stress and its effect on physical and mental performance, how to recognize and tackle stress indicators, examines effective communication and stress reduction, the importance of understanding our past and its affects on stress, breaking through old patterns of thinking, the importance and value of developing a resilience plan, and an in-depth analyses of the factors and characteristics that make up resilience. By the end of the course, the students create for themselves a personal stress management and resilience-building plan.

Rita Schiano, the course instructor, shared the following: "At the start of the course, many students believed the stress in their lives was insurmountable. I had to get my students to understand how thinking styles and habits that don't serve us affect our emotions and behavior." Each week she took them through a series of quizzes and thought-provoking questionnaires that helped them to identify and recognize their stress triggers. Next, she taught them a Kaizen approach to stress management -- making incremental change or improvement by breaking stress-reduction tasks into small, manageable steps.

The latter half of the course was dedicated to resilience building. "By reconstructing their personal stories, each student was able to identify situations and/or moments in their lives that tested their limits," she said. "Some had faced horrific tragedy, others had dealt with the loss of a spouse or child. Some were dealing with catastrophic illness. Yet, step-by-step -- again, utilizing a Kaizen approach -- they discovered the resilient skills and attitudes that they already possessed and began to formulate a workable plan to build upon that foundation to heighten their resilience."

In the weeks ahead, through story-telling, I will be looking at these skills and attitudes and I'll discuss how the ones that work, that make for resilience, can be learned and how the ones that don't work can be unlearned. This process is key to facing adversity.

Psychologist Ronald L. Breazeale, Ph.D., is the author of Duct Tape Isn't Enough and Reaching Home.

Making our Health Care systems more resilient

Adversity often comes in the form of a medical crisis for ourselves or for someone we care about. Managing an illness or injury, and the medical system that we must depend on, is not an easy task. It is obvious that we, or our loved one, must be resilient to survive, but perhaps less obvious that the medical system that we depend upon must be resilient so that the attempted cure does not kill the patient.

As reported in The New York Times (November 25th, 2010), a study of patient safety was conducted from 2002 until 2007 in ten North Carolina hospitals. The study found that 18% of patients were harmed by medical care, some more than once, and that 63% of the injuries were judged to be preventable. The good news was that most of the problems were temporary and treatable, but some were serious, and a few fatal. The author of the study, Dr. Christopher P. Landrigan, pointed out that process changes may help somewhat. However, the key for improving these statistics is through educating providers on how to identify and fix safety hazards, and by encouraging a culture of strong communication and teamwork. What Landrigan is describing here is a resilient medical system.

Other studies like those from the Institute of Medicine suggest that a correct diagnosis is either missed or delayed in 5% to 14% of urgent hospital admissions and diagnostic error rates overall are between 10% and 20%. These statistics come from research by Ian Scott, the Director of Internal Medicine and Clinical Epidemiology at Princess Alexandra Hospital in Brisbane, Australia. Scott and other researchers have found that errors in physician reasoning may account for many of these mistakes. The problem Scott points out is not just incompetence or inadequate knowledge, but it is when physicians get stuck in a particular mode of thinking. An accurate diagnosis may require flexible thinking, e.g., being able to think outside of the box.

Resilient medical systems have ways of catching physician mistakes and errors. This often involves the use of rules and crosschecks. For example, many hospitals have what is called an "ad hoc rule" that chemotherapy should not be started on weekends because the most knowledgeable physicians and pharmacists usually do not work on weekends. Unfortunately, that rule may be overlooked when someone has a rapidly growing cancer or wants to start treatment immediately. So...what to do? More about this in the next post.

Psychologist Ron L. Breazeale, Ph.D., is the author of Duct Tape Isn't Enough.