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At the heart of general practice since 1960

A GP's job is not worth dying for

The suicide of Dr Stephen Farley shows

how crucial it is for GPs to guard against stress and watch out for colleagues who are going under says Dr Simon Atkins,

who writes from bitter experience

I can imagine only too well what Dr Farley must have been going through. A couple of years ago I reached a desperately low ebb myself. I began to doubt every diagnosis I made and sought continued reassurance from my partners. I became paranoid that every consultation would result in a negligence claim, and I would ruminate about patients every night when I got home.

In the end I just wanted to curl up under my desk and die.

Studies show that 28 per cent of GPs are suffering with stress at any one time compared with 18 per cent of the general working population. Medical culture, alas, encourages the stiff upper lip approach to emotional problems so GPs tend to sweep things under the carpet and struggle on rather than seek help ­ the worst thing you can do.

My stress and anxiety started gradually following a family bereavement and soon began to spiral out of control.

I became irritable and lost interest in many patients. In fact I began to resent them. I became tearful and my waking hours were haunted by a sense of dread that stole any enjoyment I'd ever had in my job and in life in general.

In a way typical of GPs I managed to ignore these classic signs for many months, although my wife and work colleagues had noticed the changes in me.

Things got so bad I finally admitted I had a problem and went to see my GP. She listened to what I had to say, suggested I start an SSRI, see a counsellor and take time off work.

I was reluctant to do the last mentioned because I felt it was just not done and I didn't want to let anyone down, but my partners were very supportive and insisted I took my doctor's advice. So I spent the next four months at home.

Although my stress followed a bereavement, stress can come at us from any angle including work, home, relationships or financial worries. The effect though is always the same: we no longer function as we should do and frequently become anxious and depressed.

Thankfully, as I discovered, help is out there, ranging from confidential phone advice right through to referral to a psychiatrist, plus of course, a visit to one's own GP.

In particular I would recommend taking time off work. First, it provides space to take stock of your situation and get your head together. Second, because antidepressants often cause side-effects during the first few weeks of treatment making you feel worse before you feel better. And third, for the safety of your patients who need, and deserve, a doctor who's fully fit for the job.

Alongside NHS services there are an increasing number of organisations that can provide independent help. I was fortunate to link up with the Avon Cope Scheme, a group of voluntary GPs, therapists and psychiatrists who provide struggling doctors with rapid access to counselling, advice and support. There are a number of these groups around the country that can be contacted via the Doctors' Support Network.

Additionally there are telephone support lines and counselling services for doctors ­ these are listed in the box on the right.

Of course our colleagues are at the same risk of having these crises as we are and it's vital that we recognise when partners are in trouble. My colleagues certainly helped me.

Signs may include a change in mood, personality or appearance and a change in their attitude to work and their patients. Doctors who work closely together and perhaps meet regularly over coffee (an informal chance for support in itself) are most likely to pick up on these changes.

Colleagues can then be directed towards help and encouraged or forced ­ as in my case ­ to take time out.

The pressures of modern practice can be extreme and the statistics show they are beginning to take their toll. As doctors we therefore need to be better patients and to take better care of each other, because our job isn't worth dying for.

What you must do if

you start to go under

 · Recognise the signs

 · Don't try to soldier on

 · Talk things over with your family and colleagues

 · Go to your GP ­ and take their advice

 · Seek all available help

 · Take time off work

 · Learn from the experience ­ for example pace yourself better

Simon Atkins is a GP in Bristol

Useful contacts

·BMA Counselling Service

08459 200169 (BMA members only)

·British Doctors and Dentists Group Helpline

020 7487 4445

·Sick Doctors Trust

01252 345163

·National Counselling Service for Sick Doctors

0870 2410535

·Doctors' SupportLine

0870 7650001

·Doctors' Support Network

0870 3210642

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