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Independents' Day

How I found a way to survive in general practice

Dr Stephanie de Giorgio nearly quit after being a partner for just eight months. But she took control of her working life and now runs a group to help others do the same

In late 2013 I very nearly quit general practice. I had been in a partnership for just eight months, and I was exhausted and fed up. I was facing my first threat of legal action for an alleged late diagnosis, two other complaints, a falling income, and the pressures of my job as a programme director for the VTS.

I was starting to resent going to work and when I burst into tears on the phone during an unpleasant encounter I knew enough was enough. I decided I had to find ways of surviving in general practice.

My first realisation was that I had become quite isolated. I could go a whole day without seeing any of the other doctors. So I joined Tiko’s GP Group on Facebook.1 The friends I made there genuinely made me smile every day and it was like being back in the doctors’ mess. The value of talking to people regularly who don’t want something from you cannot be underestimated.

Professional judgment

The second thing I did was change how I practised. I needed to take back the control in my working life rather than practising in a way that would set me on a one-way path to burnout. The RCGP training model does not prepare you for work as a real GP, but I realised I could start to say ‘no’ and get over my fear of complaints. This subtle power shift during my consultations made a massive difference.

I learned which services are core NHS services and what we can refuse to do. This was empowering, as so much time is spent writing letters to schools or about housing or travel. I also learned to have faith in my professional judgment. If someone didn’t need a treatment, I learned to say that with confidence. For example, I had always given in and prescribed antibiotics and painkillers to people with dental infections – a classic example of covering for others’ failures and potentially harming the patient.

I could practise good medicine, have an adult conversation with the patient to make a joint decision, but ultimately, if good clinical practice did not fit with what they wanted, I now had the confidence to stick to my guns. It was revolutionary. As someone very wise put it once: ‘I shed the cardie and donned the Teflon’. Yes, I hear more remarks such as ‘well that was a waste of time’ and ‘thanks anyway’. But I haven’t had any increase in complaints and I still get thank-you cards.

The final thing I did was to give up my role in the VTS – a hard decision, because I enjoyed training. That gave me the time to set up the support group Resilient GP, with a contact I met online.2 I wanted to be part of something that could be a voice for UK GPs, providing peer support and teaching. We set up the site and social media accounts and now run courses for GPs to help them practise in a way that will enable them to avoid burnout.

A year and a half later, as anyone who follows me on Twitter knows, I am still a tired and frustrated GP, but I am back in control of my job. I can spend my time with the patients who need my medical care and get professional satisfaction. I am no longer scared of confrontation or complaints and I am willing to risk both those things to practise good medicine.

The skills I learned over the six years of the VTS job and my postgraduate qualifications in education have transferred into Resilient GP.

It gives me immense pleasure to provide peer support and education that puts people back in control of their professional lives.

As one person told us after a recent session: ‘I now feel enthusiastic about general practice for the first time ever in my career’.

There is no better feeling than knowing you have been a part of that.

Dr Stephanie de Giorgio is a GP in Kent and a co-founder of Resilient GP


1 Tiko’s GP Group.

2 Resilient GP.

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Readers' comments (8)

  • Self-control and self-realisation and not being controlled is the pinnacle of fulfilling your own life and avoiding mediocre conformism.
    Well done.

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  • Vinci Ho

    Interesting .
    Big Bang theory , all kinds of particles and antiparticles shot right out e.g. Higg's Boson before energy contracted into 'new' matter :E=mc2
    You could be representing a new 'brand' of the next generation GPs.....

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  • Secure environments GP

    For me not being a partner gives me self control and makes the job enjoyable again. I bounce into work knowing I can practice good quality medicine without the distractions. I even get home around 6.30pm as opposed to 9pm.

    Am phasing into portfolio work again, will not be a GP principal in 2 weeks. I would go into a salaried post if a practice team was safe, effective, caring, responsive and well led.... However this being the CQC criteria misses out the most important things during unsustainable workloads and unrealistic patient demands - a team that is kind to each other, that values each other's strengths, has unconditional positive regard for colleagues, that has a zero tolerance to disruptive abusive patients (off the list). Finally "good enough is fine" so nurture each other to be the best doctor they can be through sickness and in health. We are all patients. Resilience comes from knowing where this line is or more likely where it moves around for you so you feel effective, valued and happy at work.

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  • Resilence training and Balint Groups:these 2 will save you.

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  • Vinci Ho

    Finally watched Mad Max: Fury Road
    The closing aphorism was unforgettable :

    “Where must we go, we who wander this wasteland, in search of our better selves.”
    -The First History Man
    Mad Max Fury road

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  • A lot of evidence to suggest burnout is one of the biggest threats to patient care but not enough research or money goes into this area to ameliorate the risk. What evidence is there that any interventions make a statistically significant difference? I am glad doctors are speaking up about this. We need a new burnout inventory designed for doctors.

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  • Why Vinci is there more matter than anti matter ? Why are there GPs like Stephanio [ matter], when I feel more like Peverley [ antimatter]. Vinci, unless the NHS LHC comes up with some new quadra quarks, antimatter is going to win.

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  • Three years of VTS and not one minute of training for how it really is out there. Trainers are not even allowed to give you a heads up as it is not in the curriculum. We should all take the RCGP to court. Suicides, alcohol, drugs and burn out...locum, retire, emigrate

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