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Breaking up is hard to do

Dr Petre Jones has coped successfully with two partnership splits in his 17 years as a GP – and despite his long history of depression, he feels stronger for it. In the second of his two-part series on partnership disputes, he advises on how to deal with the emotional impact

Dr Petre Jones has coped successfully with two partnership splits in his 17 years as a GP – and despite his long history of depression, he feels stronger for it. In the second of his two-part series on partnership disputes, he advises on how to deal with the emotional impact

All change involves loss, but a partnership break-up often involves difficult conflict as well, and people do conflict differently. Some will try to just make it all right for everyone else. Some will turn a deaf ear to it and pretend it isn't happening.

Some will try to balance everyone's views to reach a consensus. Some will stand up for themselves but also listen to others. And some will fight for themselves, or perhaps worse, actively sulk in order to get their own way.

We all also have different expectations of our partners, ranging from close friends and emotional support, to minimal contact and strictly business only. Add to that how personally we tend to identify our role as doctor with our core view of ourselves and it's not surprising that when it all goes pear-shaped this can become very painful.

The quiet businesslike introvert may feel personally wounded when the expressive partner stands up for himself, expecting an assertive response. The introvert may say very little, perhaps because they are not expressive or because they don't expect emotional support from the relationship; but they will certainly find it hard.

Similarly the person seeking compromise will get stressed trying to hold divergent opinions together, and the one who just wants to make it all better may give in to the aggressive sulker, to the dismay of everyone else.

What a nightmare partnership splits can be. I would suggest that if everyone can talk about the issues and can admit their contribution to the dispute, they probably have a lot to offer.

The grieving process

I have been through two partnership disputes in my 17 years as a GP and in each one can identify emotional themes rather like the stages of bereavement.

First, there was a helpless bewilderment. In the first dispute I was a very new GP with little experience or power in the partnership. I was dependent on colleagues to lead the way through a difficult situation. I could express my feelings but in the end the key decisions were not up to me, even though the disputed issues very much affected me.

In the second dispute, I was chairing the partnership but the sudden changes in everyone's relationships left me floundering for some familiar certainty in a sea of disagreement.Another emotional theme was unreality.

In both disputes the familiar pattern of life was ravaged, leaving new problems to face and new things to think about. Going to lawyers, thinking about different futures and trying to imagine how the practice would be all contributed to the sense that this was more like a horrible business planning exercise than hard reality.

Of course there was anger. Friendships had been betrayed and one's right to be heard had been ignored. How could they say that about me? How could they do this? Anger tends to breed more anger in a partnership and although it eventually subsides,

I am surprised at how angry I still feel about some issues, four years on. My memories of both disputes include some quite brutal episodes between people who had worked together as friends for a long time.Perhaps arising out of the anger and the challenging situation of having to support children and a mortgage in my second dispute, I found stores of energy and mental sharpness I hadn't expected I had.

Energy to do two full surgeries, face up to a bruising meeting and still be able to write a business plan for my future. This may have been because I felt able to maintain a sense of control over my own future despite feeling the world around me was descending into chaos. In the first dispute my lack of control and experience drained my energy levels.

Mental health problems

Like many doctors I have mental health problems. I have had recurrent depression since childhood. That is a whole story of its own but the disputes had different and unexpected effects on me. The first led to a moderate episode of depression that lasted about six months, but the second came while I was recovering from a severe episode and the determination to deal with the dispute boosted my determination to recover from that period of illness.

I am now in a partnership where talking about hopes and fears and feelings is standard. It might be a conversation about a difficult patient, offloading stress in a clinical supervision sort of way.

Or it might be about financial issues such as 'if I keep the money from the HGV medicals, is it fair that you share the money from doing insurance reports?' Sometimes we argue. More often we reach an agreement. The important thing for us, as in any relationship, is to keep communicating.

This is a personal view of the impact of partnership disputes, but perhaps by recognising and talking about the sorts of feelings these situations engender we can begin to talk and listen in a way that would make things more humane, or even help prevent practice meltdown and its horrible effects on doctors, staff and patients.

  • Dr Petre Jones is a GP, trainer and course organiser in east London

Formal support Formal support

• Regional counselling and psychotherapy services, deanery funded – details on deanery websites (most regions)

• Doctors Support Line 0870 765 0001
• BMA bma.org.uk 0870 60 60 828
• Doctors as Patients, Radcliffe Publishing. Written by Doctors Support Network members – has an extensive list of relevant resources

angry

I'm surprised how angry I still feel, four years after the split

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