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Pressures of general practice are making it hard to care

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When I applied to medical school as a spotty and socially inept teenager, I remember being given three golden rules on what not to say in an interview when asked ’So why do you want to do medicine?’ The responses to avoid were along the lines of:

Being caring, sometimes, is quite hard work

’I went with my nan to her gynaecology appointment and I saw what the doctor did and thought, that’s what I want to do.’

’I used to play doctors and nurses when I was a baby and since then have watched every episode of Scrubs and I’ve wanted to be a doctor since I was a blastocyst.’

’I really care about people and want to make them all better’ (best delivered without blinking).

Mercifully I applied to a university which didn’t interview prospective students, but have recently been thinking about what it means to care about or for a patient.

Doctors (other healthcare professionals are available) are generally regarded as caring folk. We have historically been given respect and prestige in return for caring for the health of our patients, sometimes to the detriment of our own well-being. Caring is a fundamental aspect of what we do. It is not unreasonable to argue that this is particularly pertinent in general practice, where such a large part of the job involves empathy and basic human interaction and support.

Most of the time, I do care. I want my patients to feel and get better. I want people to feel that the consultation has moved them forwards with their illness (or at least towards the car park). Usually I feel genuine compassion for the people I see in each clinic. Sometimes though, I feel like I don’t.

According to the Cambridge Dictionary, care as a noun is defined as ’the process of protecting someone or something and providing what that person or thing needs’.  Interestingly, care as a verb means ’to think that something is important and to feel interested in it or upset about it’. The former definition is what we do every minute of every day for patients, whether we are tired or stressed or positively glowing with energy. Whenever a patient needs something, I’m confident that we provide it if we possibly can – we provide care for them. The latter relies upon an emotional resilience that is impossible to sustain indefinitely but often still present – we care about them.

In times of tiredness, overwhelming workload or any of the other minutiae which can creep up and sap away at one’s reserve, being asked to feel ‘caring’ presents an insurmountable challenge. A ‘caring’ doctor would ignore the practice policy and write another sick-note for a couple of days, right? A ‘caring’ doctor would squeeze in an extra patient or three at the end of the day because the patient’s employer isn’t being flexible – correct? Being caring, sometimes, is quite hard work. Being caring can leave oneself open to accepting an unsustainable workload and feeling guilty about not going the extra mile. 

The pressures facing general practice are making it hard enough to provide care - the knock on effect makes it harder to feel caring.

Dr Danny Chapman is a locum GP in east and south Devon

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Readers' comments (11)

  • Can I recommend proqol.org
    its a bit "American" but helps you look at and assess "compassion fatigue" which I think is something separate to burnout.

    A very interesting thread here, thankyou.

    David

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  • I think this is a great article. I totally agree with the sentiments expressed.

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  • I once went on a short course concerning burn out and stress among health care workers. I was told that burnout is far more common amongst healthcare workers who care 'more than others'. In addition lack of time with patients and a feeling of personal responsibility for patients needs can lead to feelings of guilt and depression. In fact they suggested that having a low level of wanting to care was ideal for a health care worker in the present NHS.....says it all.

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  • When patients need hand holding I pass them on to my female colleagues or to a freshman out of the VTS.Just don't have the time or inclination for the frills.

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  • Surely part of being a family doctor is caring. I do care about my patients - I will always try my utmost for any of them - there are some I get on better with than others but I care about all of them. The day I don't care will clearly be the day I should retire.
    I realise that it is not the sentiment of some posters on this forum, but I truly love being a GP; I am well paid to do a job I enjoy and have supportive partners and practice staff who combine to make my life a joy. I have now been a partner for 28 years, work 10 clinical sessions a week, and still love coming into work. Caring for my patients is the major purpose in my life as it was for my grandfather and father. I wish I was as good as they were but always try my best.

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  • peter u sound like a saint

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  • Nonsense - I just really like doing what I do. Of course there are frustrations - the continual messing about by health secretaries , appraisals, mandatory training and stupid referral forms when a letter would say far more in half the space. But the patients make it all worthwhile. I always do my best to enjoy every day and if you are happy, it tends to rub off on the patients. I do work in a fairly deprived poor area but on the whole I think this is easier than most other types of general practice. I used to get stressed when doing a whole weekend on call but am rarely stressed these days - would still do out of hours which I really liked, being driven round Northumberland, but the defence fees made it practically cost me money!
    I suppose I decided early on that the best way to enjoy life was to be happy with my lot, and I am.

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  • Vinci Ho

    (1) One of the virtues NHS and general practice should always honour and reward is being caring . That's exactly the argument why continuity of general practice is essential .
    (2) Respect deserves more respect in return as Chinese said 'you respect a foot in length , I respect you a yard in return.' Common sense to me.
    (3)Unfortunately , we also work in a system where we are constantly interfered by those with power in the hierarchy and instead of treating us as rational beings with respect and dignity , those in charge of this government have no respect of our profession, full stop.It is extraordinary that we (especially our next generation)are also expected to have the 'resilience' of soldiers fighting in Afghanistan and constantly checking whether the carpet is clean enough. The list goes on.
    (4) It is a shame that many of our colleagues are feeling the way we are feeling right now and there is a temptation to blame our patients who are essentially innocent . I agree to some extent medicine and politics do not mix but we are forced to deal with politics every single day. The conduct and behaviour of this bunch of politicians are self evident and self explanatory . One would wish the life of a young , vibrant and enthusiastic MP(standing out very differently from the rest of the lot) was sacrificed so as to wake up the conscience of these people running the government (and all politicians).
    (5)Sorry you feel this way , son. All I would say is our fight for ourselves as well as our patients goes on.......

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  • Everytime I meet old friends in hospitals and particularly those in frontline general practice - i'm left in awe. How much s*** do you put up with? and still manage to keep going.

    One warning just remember to care for your spouses and children, far too many of those who I admire have been rewarded with their virtue with divorce and time lost with children.

    I came to the conclusion some time ago that in the UK its not worth it. You owe it to yourselves to consider your own lives as well.

    'its a privilege to be a doctor...etc' nonsense has to stop.

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  • There are a few saints and some Mother Theresas.
    But I am human. When my pay gets copped 25% and my consults go up 50% in the same 10 years, I begin to realise I am not really valued at all.
    Read the DM, it will tell you what people actually think of saints.

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