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GPs buried under trusts' workload dump

Our misery sponges are becoming saturated

Dr Shaba Nabi

dr shaba nabi duo 1440x960px

dr shaba nabi duo 1440x960px

I am lying on an unfamiliar mattress in my holiday villa in Spain, cursing the barista while trying to get to sleep. I’ve watched the clock go from 12am to 1am to 2am, in a caffeine-fuelled daze. Just when I think I’m dropping off, the drip-drip of rain on the metal pipe wakes me up with a judder.

Flashing before me is a vision I haven’t had for more than 25 years. All I can see is her entire body shaking with the fear of her memories. I was 25 years old when I listened to her narrative of savage physical and sexual abuse endured at the hands of a man with a long metal pipe. When she could no longer hide behind her mask, she was admitted to the ward for severe depression and PTSD, and I was her psychiatrist.

As I relive these vivid memories myself, my eyes mist with sorrow. I lie here, 25 years on, and can remember every detail of her story; I can picture her clothes, her jewellery, her face. I realise my subconscious has been unlocked by the sound of rain on a metal pipe, and it is at this moment that the tears come tumbling down and I silently sob into my pillow. I realise that I, too, am suffering from a form of PTSD when the sound of a metal pipe can evoke such powerful emotions in me.

I lie here and think of all the trauma we faced in the everyday business of our role. Trauma we were too young and inexperienced to handle and with no mandated debriefing sessions to punctuate it. Our solace lay at the bottom of a pint glass at the pub, to block out all the disturbing images so we no longer had to process them.

The pint glass also meant I didn’t have to process the feeling of complete inadequacy when attempting to insert an intraosseous needle as I tried to resuscitate a four-month-old baby in my role as medical SHO. It meant I didn’t have to process the violent suicide I witnessed on a home visit, in a patient I had known for many years.

And experience doesn’t make it much easier now to process the harrowing stories of torture faced by my patients who are looking to us for asylum.

We are continuously faced with trauma in our working lives and we’re just supposed to mop it up and absorb it like a sponge. We are subjected to repeated 10-minute soakings of human misery and are expected to bring a smile to each new encounter. But what happens when the sponge is saturated? It starts leaking unless it is squeezed out to dry.

We need to be squeezed out on a regular basis but instead we are left in the corner of the sink to fester. Psychotherapists have weekly debriefing sessions with a trained supervisor; we see no less pain than them, but we are left isolated and leaky. Wouldn’t all the money that goes into appraisal and revalidation be better spent if it was diverted to provide us with regular debriefing sessions? This would be far more likely to keep us working within the profession, ready to absorb the next deluge.

Until this unlikely salvation arrives, I am just thankful I work with a great team of colleagues who do periodically squeeze me out and help make me a little less leaky.

Dr Shaba Nabi is a GP trainer in Bristol

Read more Dr Nabi’s blogs online at pulsetoday.co.uk/nabi

Readers' comments (6)

  • Shaba, thank you for this beautiful piece of insightful writing. P
    (and hope you can relax and enjoy the rest of your holiday)

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  • Ivan Benett

    For sure we are affected by the distress and sometimes shocking things we have to deal with. But to be a GP and expect these things not to happen is just unrealistic (especially in these days). Runnering through GP training, and indeed all medical training, should be a focus on personal resilience.
    We can be taught to cope with these issues, to build support mechanisms around us, and to recognise when we are near the edge. Sadly GP training seems to be overly focused on running a business, making a profit and maximising income. Now all of these are important, but our own mental health and state of mind are even more important. It may mean we accept a lower level of income, a slightly less efficient business or a more relaxed approach to maximising expenses.
    I suspect if more time is spent in training on how to manage our lives, recognise our drivers and prioritise what’s important, we would all be happier. May be our misery sponges would won’t get saturated, and fewer colleagues would get burnt out.
    Doing a workload survey is all well and good. If it is used to ask for more money it will result in simply having more more to be miserable. We must use the information to delectable on what we can do less of, if that’s what we want. I suspect most have already done this.
    We don’t need a workload survey to tell us we need more investment in Primary Care, more doctors and nurses, and better access, continuity and affective care. We do need to be able to look after ourselves, so we can look after others

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  • Ivan Benett

    Delectable = reflect

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  • Ivan - I suspect that 'affective care' is a typo. But it seems most apposite here. My affect certainly needs some care on many working days.

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  • Ivan Benett

    Ha ha indeed. We do need more affective care. I’m afraid spell check takes it upon itself to improve my words

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  • Oh my god I have said exactly this in an essay for old style TTT- we are told to reflect and be resilient- all Rick biz rubbish as long as the onslaught of 10 minute appointment with concurrent overflow of all hospital cut backs ( most of my clinics are psychiatric level mental health but in 10 minutes to manage an securely disturbed teen and their family- no psych would tolerate that-) and council cut backs ( drug, alcohol, sexual health) fall on us!!
    It’s like warfare!!!! PTSD

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