Anthony Grandelis, MD

The longer I've practiced medicine, the more uncomfortable I've grown with the word resilience.

I'm a physician — and I am also a person in long-term recovery from addiction. In my new book, The Recovery Prescription: What Addiction Can Teach Us About Fixing A Broken Healthcare System, I discuss how both of those identities have shaped everything about how I move through healthcare, and nowhere do they collide more sharply than in the culture of resilience that medicine holds so dear. We praise it like a virtue. We stitch it into wellness workshops and evaluation feedback. We hand it to struggling residents like a prescription. But in the world of addiction — the world I also inhabit — resilience is often the very thing that kills us.

By definition, resilience means the capacity to withstand or recover quickly from difficulties. It implies grit. Endurance. Fortitude. But for those of us with substance use disorders, that kind of toughness becomes dangerous. We do withstand a lot. We do push through. We keep showing up, long after we've stopped coping. We survive metaphorical fires that are burning our lives to the ground.

Until we don't.
Until we overdose.
Until we die.

That is why this word, which is meant to inspire, has grown heavier and heavier for me over the years. The problem isn't resilience itself. It's the demand for it. When resilience becomes the metric by which healthcare professionals are judged, or a benchmark for how "well" someone is doing, it morphs from an internal strength to an external pressure. It tells us that when the system fails, when support is absent, when trauma accumulates, and when we reach our emotional limits, the solution is to push through. Try harder. Don't complain.

This framing shifts the burden of coping away from the system and onto the individual. It implies that if you're struggling, it's a personal failure of toughness, not a natural response to dehumanizing conditions. This attitude perpetuates stigma around mental health by creating a culture where vulnerability is punished, not protected.

The truth is, we cannot always be resilient, nor should we be expected to. Sometimes, we're exhausted. Sometimes, we're overwhelmed by grief or trauma. Sometimes, what we need is not to "bounce back," but to stop and rest. The work of healing requires more than stamina. It requires space, safety, and compassion.

If we want to create a sustainable future in healthcare, we must stop worshipping resilience and start building systems that don't require it as a survival strategy. We must validate the moments when resilience isn't possible. And we must redefine strength, not as stoicism in the face of suffering, but as the courage to say, "I need help."

Resilience has a place in medicine, but it cannot be the place where we end the conversation. When resilience becomes the answer to suffering rather than a response to being supported, it quietly excuses broken systems. It silences those who are struggling most. Recovery from addiction taught me that real strength is not endless endurance; it's discernment — knowing when to keep going and when to stop, ask for help, and let yourself be held. If healthcare is ever going to heal, we must create environments where people are not admired for surviving harm, but protected from it in the first place. A sustainable, humane system does not require its workforce to be resilient just to stay alive within it.

My name is Tony Grandelis. I'm an OB/GYN hospitalist, a medical educator, and a person in long-term recovery from substance use disorder. Through my brand Recovering Healthcare, I explore what addiction recovery has taught me about fixing a broken health care system, one principle at a time. Today, I want to talk about resentments, which are, in my opinion, some of the most under-recognized causes of burnout in medicine.

In recovery, resentments are a clinical danger. We say it plainly in twelve-step programs: Resentments are the number one cause of relapse. The slow-burning ones. The ones we've carried so long that they've started weighing us down and have burned a hole into our souls.

Step 4 of the recovery process asks us to take a searching and fearless moral inventory of ourselves. At the center of that inventory are our resentments. We list them. We name them. We sit with them. And then we do something that initially feels deeply unfair: We look for our part in them. Not because we're to blame or because the harm done to us wasn't real. But because the only thing we can ever change is what belongs to us. And as long as a resentment lives entirely in someone else's hands, we are powerless over it. The Step 4 inventory gives us power back. It allows us to release the anger that has burrowed deep inside of us for ages.

Now bring that into medicine.

Think about the attending who humiliated you in front of the team and never apologized. The administrator who dismissed your safety concern without a second glance. The colleague who took credit for your work. The patient who was cruel to you after you stayed two hours late to make sure they were OK. Any one of these, in isolation, is manageable. But over time these resentments accumulate. Shift after shift, year after year, grievance layered on grievance. And before we know it, we are burned out, shut down, and moving through our days with a low-grade bitterness we can no longer fully explain or locate.

It is my opinion that we need to start treating resentments as a leading cause of burnout in health care. We spend enormous energy studying workload, system inefficiency, and administrative burden. We spend almost none studying what happens to a clinician who has been quietly keeping score for years.

Recovery offers a different path. Name the resentment (out loud, on paper, to another person). Feel it fully instead of managing it. Ask honestly: What is my part here? This is not meant to excuse the institution or the colleague or the system that failed you. Rather, it is meant to find the piece that belongs to you: the expectation that went unspoken, the boundary that was never set, the moment you chose silence over honesty. Once you've done that, tend to it with compassion, and then, as best you can, let it go. Not for them. But for you.

Resentments live in you. They shape your clinical practice, your teaching, your relationships, your capacity for joy. A resentment is, in the language of recovery, a poison you drink hoping someone else will get sick. Medicine will keep giving us reasons to resent. That will not change anytime soon. What can change is how we carry what we're given and whether we choose to process it or store it.

Naming resentments, seeing our part in them, and letting them go is the daily practice of putting down what isn't ours to carry anymore. And over time, we come to notice that a weight has been lifted, and we are finally able to move through medicine with more compassion, presence, forgiveness, and joy.

Anthony Grandelis, MD is the founder of Recovering Healthcare and the author of The Recovery Prescription: What Addiction Can Teach Us About Fixing a Broken Healthcare System.

Together — we can recover healthcare.