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Table 4 Type of resources or strategies applied by exemplary family physicians to resolve difficulties

From: Medical resilience and morality: a survey study on the opinions and actions of exemplary family physicians

Category Subcategory Example(s)
1) Non-healthcare: Management & Organisation (32) 23.7% Specific measures for managing activities
Working together with managers
Specific activism measures
Involving patients, managers and specialists together
Participation in commissions from management
“I limit the use of protocols when I find it unrealistic to follow them”;
“I schedule all family business for the 1 day I work in the morning”;
“I schedule home-visits“;
“I have one diary for what is important and another for the ‘little things’”;
“I allocate two slots for patients with complex medical issues”;
“I have advocated strategies for self-care and the recovery of professional dignity and have agreed with management for these to be included in the centre’s activities”;
“I’ve worked with neighbourhood associations on specific issues”;
“When a serious problem arises, we include the affected patients in a discussion on the solutions; the managers are in favour of this”;
“I collaborate on commissions encouraged by management: Pharmacy, etc.
2) Self-care, self-knowledge and “existential” activities (32) 23.7% “Friendly” physical spaces
Use of humour
Adjusting expectations/putting things in perspective
Specific mindfulness and self-care strategies at work
Spaces for reflection
Doing other extra-professional activities
Encouraging positive thinking
“I decorate the office in a bright way and change it up periodically”;
“I try to smile all the time... and it works!”;
“I try to have fun with the patients, I use humour a lot”;
“I take short breaks between patients. It only takes a few seconds to look at the next patient’s medical history and become aware of myself”;
“Sometimes, when I’m very tired, I close the door and relax for a few minutes”; “I usually set aside time for reflection/talking/having fun with a colleague who is free”;
“Physical exercise. Relaxation exercises. Relaxing with family and friends in my free time, unwinding”;
“I do other activities: theatre, literature, etc., that help me put everything in perspective”;
“I usually look ahead and think of the satisfaction I get from helping the patient with their problem and trying to resolve it or at least make it better.”
3) Teamwork /Collaboration (23) 17% Encouraging solidarity and shared experiences between team members
Task delegation strategies
Specific nursing strategies
Working with social services
Specific strategies with specialist colleagues
“I try to enjoy the shared moments with the team”;
“I share my experiences (critical incidents) with my colleagues”;
“I collaborate in working groups with colleagues on specific aspects for improving healthcare”;
“By coming to agreements with my staff, I have been able to delegate many actions”;
“Participation in multidisciplinary groups with specialists, nurses, etc.”;
“On the team, we’ve included social services in many decisions”;
4) Healthcare (15) 11% Optimising Primary healthcare strategies: longitudinality; education, health,...
Joint care with nursing
Focus on problem-solving in healthcare
Encouraging “complete care”
Use of new technologies (ultrasound)
“I use my relationship with and knowledge of my patients for many things, e.g., if I’m overloaded 1 day I ask them directly if they can wait until another day”;
“Training and supporting nurses to carry out self-limited minor processes”;
“Supporting triage operations in appointments to assess whether a doctor or nurse appointment is necessary and prioritising these accordingly”;
“Being ‘present’ at each point, I can forget about the superfluous”;
“Focusing on the care of the patient I’m treating and not thinking about the waiting list, delays, absent colleagues, emergencies...”;
“With the incorporation of ultrasound I have gained both in decisiveness and in relation to my patients.”
5) Doctor/Patient/Colleague relationship/ (11) 8.1% Trust
Actively empathising
Being assertive
Prioritising respect and kindness
“I always try to improve the trust my patients have on me”;
“I consciously strive to empathise and try to understand other points of view”;
“I avoid conflict with conflicting people”;
“I’m assertive but always respectful.”
6) Non-healthcare: Teaching, Research (10) 7.4% Participating in new projects
Teaching residents and students
Ongoing education
Research
“I get involved in other projects: research, publications, conferences, teaching... I like it and it lets me escape somewhat from the pressure of the clinic”;
“Training, teaching residents, community activity.”
7) Low pay (2) 1.5% Adapting to income
Moderating material desires
“Throughout life you adapt, it’s about wanting less, about what you are more than what you have.”