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This is it. From now on, I choose life

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I am neither religious nor spiritual. Yet it is the Serenity Prayer I refer to most in times of need: ‘God, grant me the serenity to accept the things I cannot change, courage to change the things I can change, and wisdom to know the difference.’

Although I have saved my sanity, I feel huge guilt

As an educator who has indulged in extensive navel gazing, I am aware of my strengths. I know that courage, but not serenity, is one of them. So I’ve spent the past nine years as a partner trying to be courageous and change things. I’ve tried to manage patients by ensuring consistent practice policies. I’ve tried to manage demand by discouraging dependency and fostering a culture of self-care. I’ve tried to manage recruitment by diversifying the workforce and creating a supportive training environment.

But this is a battle where I am faced with weapons of mass destruction and all I have is my bow and arrow. Occasionally, my arrow may land on target, but I am exposed to a lethal and toxic environment, where eating, breathing and sleeping my struggles becomes the norm. A place where I daren’t switch off for fear of being unable to switch back on. A cocoon that may appear warm and comfortable on the outside, but is slowly destroying me on the inside.

So, because I was never going to do serenity, I moved away from courage and on to wisdom. The wisdom to realise that the contract was making me drained, cynical and depleting me of joy. And I used the courage to turn my back on it and walk away.

By the time you read this, I will no longer be a partner. The role that 10 years ago was being pursued by hundreds of applicants and I felt so proud to achieve. The role I moved cross country to undertake because it was almost impossible to secure a partnership in the South-East in 2006. In stark contrast, our practice now has unfilled vacancies for three whole-time-equivalent GPs and I know we are not alone.

So in spite of rationalising, innovating and merging, I was unable to shake off the burden I felt on a daily basis. My pessimism was malignant and insomnia the norm, as I lay in bed worrying about my business going under and having to sell my house to pay off the liabilities. There was a nausea that grew over the course of a Sunday evening and I started dreading my job and resenting my patients. The final nail in the coffin was the stark realisation that I felt anger instead of empathy when a GP colleague went off sick. That was the trigger for me to complete a burnout questionnaire; the results were so disturbing I gave notice of my partnership resignation that very evening.

Within a few weeks, people noticed how much more relaxed I looked. My brain started filling with creativity instead of anxiety. Yet although I have saved my sanity, I feel huge guilt for turning my back on the independent contractor status that I still believe to be the most efficient way of delivering primary care.

But I’ve chosen my sanity and I’ve chosen my family. Most of all, I’ve chosen life. Because life is too short and too precious to be a scapegoat for the NHS.

Dr Shaba Nabi is a GP trainer in Bristol

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Readers' comments (53)

  • Azeem Majeed

    "In stark contrast, our practice now has unfilled vacancies for three whole-time-equivalent GPs and I know we are not alone."

    Very true Shaba. My own practice in Clapham in London has a vacancy for a full-time GP post we have been unable to fill despite advertising repeatedly.

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  • I love being a partner and look forward to each day's work. I'm sorry this is written in crayon but i m not allowed anything sharp in here.

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  • Well done you- I wish you the best

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  • I hope things get better for you.

    Another pulse columnist down?

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  • You express accurately and beautifully exactly how I felt before resigning my partnership at the end of 2013. No matter how hard I tried it became clear that I could not change things positively enough to make it tolerable. I, too, did a burnout questionnaire and was shocked. I too had been a trainer for many years and had once lived my job.
    However, 2 years on life has never been better and I have found the person I had lost. I am beginning to like and respect myself again and rediscover pleasure in things that I had forgotten existed.
    To anyone in the same position ( and there are many of you!), take the plunge. You will not regret it.

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  • Bravo. That is all.

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  • Shaba, you have so eloquently described what so many GPs are going through right now. Well done on another fantastic article, I think it will be a trigger for action for many that read and identify with it.

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  • How will you square it with being a trainer Shab?..are you still eligible to carry on that role?

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  • I am not altogether surprised.The disillusionment in your postings was coming across loud and clear.Do you not admit,knowing how you felt about GP,that you were being a tad hypocritical by encouraging youngsters to enter general practice in your role as a trainer?

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  • I too resigned from a partnership last year having gone from burnt out to full blow severe depression as a result of the constant demands the job entailed. I had been there for more than 15 years. I knew that unless I made the move I would end up ill again. Now I'm a very happy, relaxed and fulfilled locum working 8 sessions a week with Pallant Medical Chambers, I am working less hours than I did as a 5 session partner! I now love being a GP but it is very much on my terms.

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  • You describe perfectly how I felt before I took the leap and retired early
    Don't feel any guilt
    Enjoy your life and your family
    Good luck

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  • Dear Shaba, I too resigned from my partnership this month. If was just taking too much from me and I had nothing left for my family apart from a stressed out creature I no longer recognised. I also feel awful about having to go but I am happier already than I have been for years. I wish you all the very best.

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  • There are so many medically related things we can all do now and there are also many non medical things where they value your skills. You only have one life so live it on your terms.
    I found 1 career coaching session with the BMA put me on track to a portfolio career that I love and fits around my family.

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  • Ditto we handed back our contract last year when pregnant with twins. The financial hit while unable to work was well worth it as I actually have some family time (little me time but that's the children!) and I took now recognise my self again. I had lost myself to stress & worry.
    Good luck

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  • It makes me a bit uneasy when a fully grown and educated person relies on a burnout questionnaire or PHQ9, or 6-CIT or some other supposedly validated tool to justify their decisions. Sorry it has nothing to do with Shaba, good luck to her, by the way. Maybe whats lacking is a healthy portion of cynicism and common sense, then life doesn't seem so bad.
    I have no plans to resign my partnership position. Doing ok on 10 sessions and growing my special interests. Just saying.

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  • I hope it turns out to be the right decision for you, Shaba, and I hope your career, whatever direction you take it in, is happy from now on.

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  • You were my appraiser Shabba, and when I sobbed on your shoulder earlier this year when talking about my difficulties with my previous role you were so very empathic, helpful , constructive, all of the right things. Thankyou for all your help and I know that you will find the right balance, as I (hope) I have. Things have changed in medicine, we need to too, doesn't make us bad doctors, shouldn't feel guilty about it.

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  • 5.14 how uncaring and unsympathetic you sound. Trainers do not "encourage youngsters to enter general practice". We are responsible for them only AFTER they have made the decision to enter GP training schemes themselves. We generally look after them very well, but I think most trainers would give their trainees a real world view of the challenges facing GPs today.

    8.35 you too sound uncaring, unsympathetic and dismissive......I hope you don't share your views with the many patients you must see as a GP who are suffering stress and other health problems because of their job. I am happy that you seem to find 10 sessions easy, but you are in the tiniest of minorities given that most of us strive to achieve a healthy work life balance. This is actually part of fitness to practice. I fail to see how "a healthy portion of cynicism and common sense" can help in any way, shape or form.

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  • Very well done for ditching the contact x

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  • Kevin Hinkley

    Beautiful writing. I wish I could write with such intensity and such honesty. Thank you

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  • No need to feelguilty Shaba. Good luck with the next phase of your career.

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  • Great piece of work, thank you for your honesty and prespective. We are all to often overburdened, underresourced and with unreasonable expectations. Looking after our work life balance is so important.

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  • It is time that the GP Partnership model comes to an end in the UK. It is not fit for purpose any more. Payment per consultation and removing practice boundaries is the only best alternative.

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  • Please reflect and write on how you are feeling in one year and share that with us.
    Only when you get away will the burn out that permeates this writing shine through even more acutely.
    I think it's is great that you have made a decision but I feel so concerned that for so many of us the decision is just that: to walk away.
    And this is a symptom of a system that is unsustainable for the majority
    Take care x

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  • I'm posting from New Zealand, where we are paid up front per consult by our patients. The consult is 15m, but if it turns to custard and you need to go longer, folk wait. We are desperate for good rural gps, loosing a cohort of 25-40yr olds to specialist jobs when student loans forced med skool grads to ditch gp for higher pay. You won't always feel so negative. Come practice in the sun where patients still say thankyou, and heal ❤️🌞🌻🏖

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  • Thanks Shabi, good honest effective writing.

    Its boiling frog syndrome. Sometimes you are aware its getting to hot and jump out, sometimes you do not realise its hot and die in the boiling water. Some frogs can tolerate the really hot water and keep going. Its a variable picture and can be difficult to know what type of frog you are. Self awareness tends to go when you get chronically stressed or ill with depression/anxiety and you often stay in the water because you lack the capacity to think clearly and take action. If you can hack it fine, if not take a deep breath and jump out because you have great skills and there is lots that you can do which is rewarding, fun and pays the same/more. Look up, look around, actually its a big wide world out there with lots of new stuff going on more in tune with these times than the single Practice/Partnership model which the government clearly do not support.

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  • Vinci Ho

    Life goes on
    All the best

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  • Pev,Nabi, Copperfield all say the same thing. GP land is awful for many. But there are practices with extra funding for patients who feel fine.
    Today's news on Sunderland failing children's services gets a new boss, but hey MORE money and staff. Absurd. If they had done that first, it would not have failed.
    Same here in GP land. All the Trusts are in the red, but get bailed out.
    We GPs do not. We just keep on taking pay cuts.
    Pay per item has fallen 55% in 10 years. [ 25% less absolute pay for a 60% increase in workload].
    Only Maureen thinks there has been no better time to be a GP.

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  • Do not doubt it, you have done the right thing by yourself and to your partners and patients. Many of us keep turning up at the practice at the start of the week, is there actually an end, because, just because. Many of us used to want/love/need to be at our practice to feel complete but when the want/love/need goes or has gone it's time to leave.
    I left my the practice after 27yrs but it took a prolonged period of leave, doing something completely different to open my eyes and make me realise that I had reached the end of my time at the practice but not in medicine.

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  • Sad to hear it Shaba, best of luck.

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  • Yes, it's best to resign when the work becomes overwhelming as we have to have patients safety our top most priority. Our patients should never be treated by doctors when they become who are tired, exhausted, demoralised, etc as this is not good for both doctors and patients.

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  • Well done Shaba and all the very best to you. At least you are not sustaining this awful system anymore. The more of us that leave our posts/resign the sooner change will be forced through.

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  • Whenever I start to feel like this, I ask myself with which patient of mine I would want to swap places. In 16 years of being a doctor and 10 years of being a GP, I've only come across one patient with whom I would have liked to swap places and he was (still is) an international rockstar. Perhaps we need some perspective.

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  • I too have just resigned my partnership after 11 years. I was feeling the dread seeping into the Saturday night , not just the Sunday and when I couldn't sleep for worry on my week off over New Year , I knew I had to leave. I now work as a speciality doctor in secondary care and could not be happier, even though I am a lot poorer!! Good luck and I hope you find your mojo again!

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  • You have made the right choice, a difficult decision no doubt, but one which will probably save your sanity. I was a partner many years ago and wouldn't go back to all that extra stress again for anything.

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  • Well done - q18 /12 post partnership still in recovery . Saved my marriage but still recovering from the emotional damage of 20 years in Partnership.
    Get out don't look back - life is so much better on the other side

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  • Well done for doing what was right for you. I really wish you the best for the future. I fear for the future of general practice, when I hear about such doctors resigning, and about the new generation not wanting to take on salaried posts or partnerships.I do hope we do not loose you as a GP, as others have said a portfolio career on your own terms seems to be the way of the future. We really need our leaders to look at how we can change things urgently so that others aren't forced to quit to improve their own health. There has to be a limit set on safe numbers of consultation and adequate time to do prescriptions and admin work for all health professionals in primary care. The job is so much harder than 10 years ago with the complex frail and the amount of work that is expected from primary care.

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  • me too.

    fully understand.

    best wishes

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  • Patients know how busy doctors are and the poor work life balance
    The other day it was really beautiful outside..
    An elderly patient remarked.. How nice it is...but I don't think you ll.get to enjoy it stuck in here........
    I'm a LOCUM... I told her,
    I enjoyed the day off before ...
    And had a smug smile
    knowing I would in fact enjoy this day as well
    Work to live....not. Live to work

    They say that all you earn after 50,000 is actually linked to higher stress and at a cost to the best things in life which are free....

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  • Like Ferris Beaullar said... Life moves pretty fast... If you don't stop to look around once in a while....
    You might just miss it

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  • wow - this thread is like an inaugural AA meeting with all the tales of woe and self-congratulatory salutations!! She's left partnership not being a GP or trainer - it's called prioritising, we should all try it.

    Best of luck Shaba

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  • If possible try to pass on your skills and empathy to our GP trainees.
    You are a big loss to general practice and unfortunately for general practice too many good doctors are taking the same route.
    General practice has impacted on me in a negative way, my marriage just over, off with stress for a year and have managed to come back as we have a very capable highly motivated practice manager and very supportive partners. i also plan to leave general practice as soon as I caN.

    Best wishes

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  • Best wishes Shaba. I left my partnership at the end of last year and feel a million times better. I finally have my life back. When I resigned every GP I met subsequently congratulated me on my decision. Not one said that I was making the wrong choice, whilst people who have no idea the toll that the job as it is takes on one's mental and physical health could not understand why I was leaving.I used to love my job, thinking it was the best job in the world(and it was then), but over the last 15 years it has been like a millstone around my neck. I have let tht stone drop to the bottom and I have floated to the surface, thankfully. I have been offered numerous partnerships in the last 6 months, but there is no way that I am ever going to be a partner again.(a very sad state of affairs)

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  • So well written and accurate. Why does this job we all started because we love what we do drain the very life from us?

    I'm lucky enough to have moved from full time to part time in my later years and only do private work which is not so stressful and I enjoy it.

    Good luck Shaba. There is life after the NHS in spite of what they tell you.

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  • Anon. 24/5/16 10.40am

    I think the fact that you are salaried is the issue. Most doctors could cope with that kind of lifestyle.

    Being a partner is the most crushing.

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  • Let us put life in perspective.
    We don't have missiles thrown at us, infectious diseases, militia, poverty, dirty water or the threat of no meal tomorrow. Just a GMS or PMS core contract.

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  • I recently resigned my Salaried job. I loved the continuity with Patients, but as a locum I can choose how many to see and how long I see them for. (15 mins works for me). I charge for the number of patients I see, not the time taken to see them. I am not stressed (any more!)I feel like I have got me back and I love being a GP again. I have been a GP since 2002. The job is unrecognisable compared to when I started such a short time ago. Hope you are now ok and best wishes for the future.

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  • Good luck Shaba.
    Don't hang onto the anger.
    Tip - if you're going to take your pension early, brace yourself for NHS Pensions being swamped by applications and start early!!

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