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How I dealt with a stressful practice break-up

In the second feature in our short series on GP stress, a GP reports on how a practice break-up put him under a great deal of pressure

In the second feature in our short series on GP stress, a GP reports on how a practice break-up put him under a great deal of pressure

It was not a "Road to Damascus" event - a sudden realization that the practice was not working.

It was the gradual feeling that I was carrying the practice. I was starting earlier and working later. I was attracting all the patients with the thick notes.

But was this only a perception? Statistics didn't help. We were seeing an equal number of patients and the work appeared to be spread evenly.

But evidence was building. One day my partner left for a hospital session which I knew had been cancelled. Then his GP registrar asked to change practices and complained to me about the lack of teaching.

I found myself getting more and more stressed. I realised the problem was that I no longer felt in control and could never seem to prove anything.

I didn't have any problems sleeping but I did find myself becoming snappy and intolerant. I also found I was developing a closed mind. New ideas were always "nonsense". When challenged over a patient's management I became angry and defensive instead of listening.

Once the A&E department sent a patient to the practice so that we could redress a wound. They said they were too busy. Our nurse was away, I was under pressure, so I rang the department and shouted at the A&E sister. I think I had a point - but I ruined it by losing my temper.

I tried to be professional, I found keeping a diary helpful. Writing is cathartic. It helps to focus a "sea of troubles" into a manageable size. It also gave me objective evidence about what was going on.

Then the half time partner also complained about the way the practice was being run and the general atmosphere. She said: "We do not have to put up with this". Was she helping the situation, or was she being my Lady Macbeth, planting murderous thoughts in my mind?

But by then I had already decided that the only thing to do was to reassert control, to take positive action.

I decided it was time to bring the problems into the open. We arranged to have a practice meeting with just us three GPs – two full time and one part time. The practice manager was not asked to attend.

We discussed evidence – visits which had not been done, non-existent hospital sessions. We agreed to meet again in one month.

At the next meeting my partner told me he wanted to leave. His solicitor had advised him that we had no legal grounds for action against him, but if we felt this strongly about his performance the practice was no longer viable. He would take his registered patients and become a single handed GP.

After two years he merged with another local practice.

Hindsight

Looking back, lancing the boil and bringing matters into the open was the best thing I could have done.

It has been said time and time again, and I can only repeat that it's true, that not being in control, bottling things up and feeling resentful is one of the biggest causes of stress. I remember one day, just after our practice meeting, when I was still wondering whether I had done the right thing, a rumour went round suggesting that the whole idea of the break up had come from my non-medical wife.

In fact I had not even told her of my plans until after the meeting and I was left seething with indignation.

I should say that one of the most important antidotes to my stressful situation, apart from my taking action, was the support I received from my staff and patients.

Obviously this is not something one can do anything about, but the fact that most of the staff wanted to work for my practice was a great comfort to me. They made it clear they understood the problems. I did not want to bring them into the row but they quietly let me know I had their support.

I also found support from patients a huge encouragement. Again I made a point of not involving them in the dispute, but many understood.

Was I right to challenge my partner? Should I have waiting until he retired? I may never know but I did allow me to take back control of my working life.

The downward spiral The downward spiral

What caused me stress
- Poor relationship with GP partner
- Feelings of lost control
- Feelings of uncertainty
- Feeling I could never prove my point

Signs I was stressed
- Irritability
- Closed mind
- Feelings of resentment

How I resolved the situation
- Brought my fears into the open
- Wrote my feelings down in an diary
- Took positive action to remedy the situation

Not being in control, bottling things up and feeling resentful is one of the biggest causes of stress.

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