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Why I love my job? I no longer care

The winner of Pulse’s writing competition, an anonymous GP, explains how he has managed to keep his career and his mental health

I’m quite enjoying work right now. There, I’ve said it.

My exception to the rule? I no longer care. The QOF, QIPP, LES and DES; the acronyms roll in effortlessly from the crooks and nannies of the new bureaucracies. Let them – they’re tumbleweed to me now.

What is it about our profession? We have the counter-intuition to do it all, irrespective of time or any concept of work-life balance.

For as long as I can remember, the Department of Health has plotted ever-more untenable workloads, its sums reliant on our failure. We find ourselves endlessly balking at the shockingly expanding days, duly delivered within an inch, and including never-dreamed-of maximums. More boxes, more hoops, more targets? Bring ‘em on. Then they snip the promised rewards, shorter-back-and-sides, and we still bloody do it.

So I’ve stopped – unless of course my partners are reading this. And do you know, I feel neither bad nor guilty.

I used to be like you. I used to lap up the guidelines every April, the lists of changes and challenges. I absorbed it all, a perfect lickspittle excreting lip service, pleased and proud of my self-flagellation. And then I broke.

Born again

At your next practice meeting look around. Who is the pillar of reliability, the wise owl senior partner? That was me, except when I went home I wept in my bed in fear of the forthcoming day.

I was lucky. I had the support of a wife who placed more value on the man than the monolith. I had partners who felt how close the grace of their particular God had scraped by them. I had an excellent GP, able to observe symptoms, ignore my self-diagnosis and give me the treatment I needed. I thank them all.

I survived. It’s true that serotonin reuptake has been part of this, giving me insight into these drugs and their actions. They’re not for all, I know, but, if your friends can tolerate the barking and car-chasing phase and, more importantly, you can accept the need to go through that, I hope my experience helps.

I’m back at work now and I love it. I have remembered and realised the truth: that we are not necessarily here for the good of our contract. Take a step back from ticking your boxes and look – actually look – at the person in front of you, who, unless you’re reading this during a meeting, is likely to be a patient.

And listen to them. The chances are you will enjoy the process, though perhaps you had forgotten you would.

My slightly sickly born-again experience was bolstered by me absolving myself of my responsibilities. But it’s working for me.

The author, a GP partner, wished to remain anonymous.

Pulse asked for talented GP writers to send us stories to inspire and amuse their colleagues, and we were bowled over by the quality of the entries submitted.

Nearly 30 GPs took the time to put pen to paper – or finger to keyboard – and entries varied from amusing tales from consultations to clinical dilemmas or political ideas about general practice or the NHS in general.

Click here to read the winner and all the runners up.

Readers' comments (16)

  • Ah, the quintessence of GP land. Who looks after us GPs ? Do we have this strange thing called an Union ? Never mind, they are looking after the NHS, not realising one day the NHS may not be there because they have not bothered looking after the little straws. The horror is this - there are colleagues going bankrupt doing 12 hour 40 patient days - and the GPC sits on it hands twiddling its thumbs - if you forgive the mixed metaphors.

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  • Great coping strategy-I like it!

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  • Good to hear you were not afraid to take both help and medication to get through the bad phase. I'll make that my role model!

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  • This is a very familiar story that reflects my own. It is tremendously liberating to regain the confidence that you are a good doctor who can see and manage patients with relative ease, and that the contractual hoops, in the overall scheme of things, are not important. I'm glad that we both survived!

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  • An excellent article and I am so pleased a reasonable outcome for the GP.

    The problem is that, unless we jump through hoops, we go bankrupt.

    That is why, in my experience, practices function best when all the partners take responsibility for clinical and managerial issues as well as the simple strategy of setting and achieving (yes those horrible) targets and objectives which sadly have to be met for the survival of the organisation. Oh dear, I sound like a manager, and an unsympathetic one at that! I don't think I am really.

    Many other GPs have stated in their contributions in the comment section that their personal solution to this dilemma was to become a locum -- because then we are absolved of the requirements of the above paragraph -- for those of us in small practices particularly, this may be the only feasible solution to this dilemma.

    in conclusion, the last thing this comment means to convey is any suggestion of criticism for doctors who decide to stop ticking all the QOF boxes -- quite the opposite.

    The point is that, the solution which works for the individual, will not work for the profession, because this is our contract which we face as a daily reality -- either the contract changes(which only our leaders can achieve), or individuals make their own decision and leave to become locums, go on sick leave, choose an alternative career or retire.

    All the evidence is that, in the current mass exodus from the profession, individuals are exercising their choices to do all of these things.

    Personally, I suspect we are past the point of no return -- NHS GMS general practice, RIP. Sad or just simple reality? Who knows?

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  • @8.45 i second this statement but would like to add that if your GPC is not doing the thing you want - then what would you do??

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  • Secure environments GP

    I believe this sentiment is genuinely the tip of the iceberg, itself surfacing very fast and about to hit the "NHS Titanic"...

    When you’re burned out, problems seem insurmountable, everything looks bleak, and it’s difficult to muster up the energy to care, let alone do something about your situation.
    Forget you are a doctor, this is where other people with safety-nets come in, your own GP, the local "wise people", your partners (if you were lucky enough to choose them well). I count the BMA and other leaders in to this group for perhaps not doing enough to throw life rafts out and steady the ship.

    If constant stress has you feeling disillusioned, helpless, and completely worn out, you may be suffering from burnout. Take heed. Depression is down the track, be ready for that freight-train. Stress & depressions effects on cortisol and serotonin are the biological reality. I wear glasses and without them am virtually blind, and I do not feel shamed by my lenses or by my need for them.

    I'm glad the authored returned to work, for a committed patient-centred doctor it is a coping strategy in itself. It can help you heal, fully realise your contribution and regain your balance. Those too young to retire or unable to emigrate quickly see building up resilience one of not many choices left !

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  • I care, but care less. I feel 'twixt being too young to retire but old enough to feel burned out. However having most of my career behind me I've filled my pension pot and am lucky enough to have been allowed to retire at 60 - bring it on! My partners are however 10 years younger but facing 15+ years before their undoubtedly less generous pension - how do I support them as 'not caring' is not an option. Financially we are earning less and less, investing less in infrastructure, replacing staff less often and generally half the practice we used to be. We don't recieve the 'love' we used to get from on high and suffer the demoralisation and haven't the strength to dig ourselves out - ANY sort of hand up is missing and we are slowly drowning. As senior partner I once had ambitions of leaving some form of legacy - no more.

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  • Vinci Ho

    (1) hope you get better and better. Fact-we need to look after ourselves before looking after the others, by all means. This is a war with casualties .
    (2)One needs to believe what one says or does everyday to keep sanity and soul intact. This cannot be bought by money .We are people's doctor and with a halo on top of our heads in contrast to shameless, despicable politicians/bureaucrats with no honour.
    (3) One day , when I stop believing what I am believing , I will stop and leave. (No worries to those who do not like what I have been saying)

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  • Secure environments GP

    There is no question that in "some doctors" (Not all) burnout has an obvious knock-on effect to patient services. Surely if a similar crisis was happening amongst airline pilots there would be an immediate impetus to reduce or change unnecessary and excessively complicated administrative procedure. Reduce/mitigate organisational factors that risk pilots losing their focus doing the job they were trained for and presumably enjoy. Happy, respected and cared for people are more productive and safe workers. It's not rocket science...Being made to feel bad not ill serves neither the doctors interests nor their patients. The whole system seems set up to give patients rights but doctors none.

    As Dr Clare Gerada has said "The GMC is “traumatising” unwell doctors and may be undermining patient safety. (BMJ 20th May 2014)

    It is so sad that this needs pointing out so bluntly; that failing to attend to the needs of one group of patients (doctors) does nothing to benefit the wider population. I think doctors need to be treated more fairly especially under the current pressures.

    The difficulty with being a GP Partner is the relative lack of employment rights. If we were employees we would not let our "employers" act in this way, look at EWTD on hour for Junior Doctors. Nor would a Union for employees stand for it or we would change to a better Union. The Government can carry on heaping on the pressure with impunity, as they will not see a surge in Employment Tribunals and legal cases calling to account the employers (them and whoever they may be).

    It is sad that proportionality may be lacking. Rates of mental health problems (already high) amongst doctors are rising further under the current climate. If managers (and regulators) do not respond both sensitively and proportionately in line with these pressures they will run into difficulties as more doctors become the patient ! (which may be through no fault of their own). What then? Sadly for many fear, uncertainty, isolation and financial ruin to add to their illness or an even worse outcome for them and their loved ones. Or they exercise choices and retire early, take a back seat (like the author perhaps), emigrate, change careers, reduce sessions per week (adding to workforce crisis) and diversify work patterns away from the "front line".

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