Some thoughts on resilience.

As a biologist first, with medicine as my second career I often think of resilience as it applies to the natural world. If humans were wiped out by a meteorite or a new pandemic tomorrow it wouldn’t take very long for vegetation to engulf our cities and erase the superficial evidence of centuries of modern human domination. Thirty years after the Chernobyl nuclear reactor exploded, plants and animals flourish in wonderful diversity despite levels of radioactivity expected to leave the area as a desolate wasteland. 
a resilient thrift flower surviving in a rock crevice beside the azure waters of the north Cornwall coastline.

A resilient thrift flower surviving in a rock crevice on the north Cornwall coastline. 

Histopathology as a diagnostic speciality has been resilient in maintaining its relevance with the advances in different types of radiology imaging, and oncologists’ increasing appetite for tumour agnostic genetic testing to identify drug targets. Maintaining resilience in our speciality will however be an increasing challenge in the coming years, with volume and complexity of workload continuing to sky rocket, without a corresponding increase in staff numbers and specialist expertise. We are therefore being forced to rapidly adapt and develop strategies to maintain and enhance resilience. 

1. Staffing

NHS budgets are tight and departments need to develop a proactive approach to staffing, anticipating periods of staff absence and retirement with recruitment applications, and attempts to find locums to fill short to medium term periods of absence. Staff who had previously covered speciality areas may be difficult to replace “like for like” with new post fellowship consultants. Managers cannot reasonably expect new pathologists to produce the same numerical output as a retiring predecessor while simultaneously learning to adapt to new workplaces and unfamiliar IT systems, especially when they might be trying to learn to develop new sub-speciality expertise, being careful to avoid misdiagnoses.  

Collaboration in a multiple hospital region may enable the possibility of sharing certain resources, with outsourcing of slides and or wet tissue to other NHS or private laboratories during short staffed periods. In our region we are embarking on our journey into digital pathology which we hope may allow a more dynamic way of reporting speciality cases across our region, and therefore reduce the number of duplicated and unnecessary external review cases. I do hope however that improved technology should not mean reduced staffing, as I think there has been a gradual erosion of the quality of reporting in order to cope with increased demands. I have also noticed that technical and admin staffing levels and consequently support in these areas seems to have decreased during the time I have been practising histopathology.

2. Collaboration and communication

Open communication and collaboration is vital to the resilience of any team working environment.  This includes regular open and honest feedback and support, with recognition of different team members’ values and contributions. With increased use of teleconferencing it may also be possible for speciality teams at different sites within the same regional network to collaborate regularly and share expertise or even alternate MDT cover between sites.  Job planning should reflect not only reporting numbers but other valuable contributions to the department such as teaching, training and quality control.

3. Prioritising well-being with Igikai

After many years of working in a large organisation it is easy to lose sight of what initially attracted us to working in our current jobs. Reflecting on the areas of work and daily life that bring us satisfaction is critical to maintaining resilience and preventing burnout. I apologise for using another example of Ikigai in two successive ACP news issues (see below) but I think it’s relevant again when considering maintaining our own mental well being and resilience. Thinking about the main headings around the outside of the diagram below might help us concentrate on our own personal sense of well being and maintain resilience. 

-What you can be paid for. There is a satisfaction of ploughing through lots of easy cases and knowing that we are being paid handsomely, especially when doing extra work out of hours but we must be mindful of not producing a two tiered system where all the quick and easy work is done out of normal working hours and all the difficult stuff is done during NHS time. We need to maintain balance between these different types and complexities of work to maintain our mental well being and keep bums on seats in the public sector. 

-What the world needs. It’s clear that our work is needed by the patient, and although many clinicians might see a histopathology result as a tick box exercise, I’m sure we all have clinical colleagues and specialities where we feel most appreciated and needed. This conveniently links in to the next Ikigai headings below.

What we love and what we are good at. Thinking back at why I chose histopathology as a career and my love of the natural world I perceived I could combine these passions and skills. I also had a hunch that the photographic pattern recognition skills I had as a junior ornithologist being able to obsessively name every species in the Collins bird guide might come in handy one day!  To be honest, although there are still times when I love my work, these are reducing in frequency as the interesting and intellectually challenging work is increasingly replaced by mundane administrative tasks! 

In contrast to other specialties, where shift working with nights and weekends might mean colleagues rarely see each other in or out of work hours, we are still fortunate to be in a speciality where most people work 5 days a week or less and we can see most of our colleagues on a daily basis. Regular social gatherings can be difficult as our lives become busier and more complicated and those of us with busy jobs may already feel guilty about not seeing our families enough but seeing colleagues in another context can be very beneficial. A regular weekly tea / coffee break can open up stale lines of communication.

Team-building events can be an awkward or cringeworthy thought but can reinvigorate working relationships and create an environment to connect and learn about each other’s methods of problem solving and other characteristics to contribute to a team’s future success and sustainability. Our clinical colleagues have recognised the importance of team building events for the prevention of burnout. My physician wife runs “remote and restorative” medicine courses in various spectacular outdoor locations in the south west which certainly seems popular although no pathologists have signed up yet apparently!

As an individual now “senior” consultant pathologist in a region with an extreme workforce crisis I have a tendency to think that the next generation of pathologists and laboratory staff will have to be the ones to develop resilience to tackle the problems threatening our speciality. Just like the climate crisis, the older generation can say it’s someone else’s problem, or we can all make efforts to find our own form of resilience, and try and ensure the next generation has somewhere to practise their skills!

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