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The profession must face up to the reality of GP burnout

GPs must be honest about the stress and workload they face, and should be taught tested coping strategies, writes Dr Sarah Khan 

Eighteen months ago, a friend and I were at a music festival, and came across a junior doctor who we befriended. She told us how difficult she had found her F1 year. She had felt unsupported, stressed and exhausted. Having completed her medical degree as a mature student, she was shocked as to how difficult an experience it had been. 

My friend and I recounted our own experiences as junior doctors, how we had sometimes felt unappreciated just as she had.

We returned home from the festival feeling exasperated that some things hadn’t changed, that the system was not improving, and that bright, enthusiastic young minds were being frazzled at such an early stage in their careers.

So we came up with the idea of a social enterprise that we are still developing called Healing Doctors. It’s not good enough that, after thousands of pounds of investment and countless exams, doctors are not equipped with the skills they need to prevent burnout. Medical students need to be taught coping strategies, rather than dealing with difficult situations by following them with a four-hour drinking session at the local pub.

On the rise

In the last few months there has been an increase in reports on GP burnout. Whilst this is sad, worrying and of concern; the increase in awareness is welcoming and GPs are starting to admit the impact our profession is having on us. Not only do our patients expect high quality medical care, we constantly provide relief, sympathy, comfort and reassurance. We perpetually fill forms and tick boxes, whilst gathering evidence for revalidation, hitting our QOF markers and coping with the constant NHS changes that each new Government throws in our direction.

How many of us will admit that, to prevent burnout, we need to re-educate ourselves and practise what we preach? What would we tell our patients if they complained to us of early symptoms of stress? Exercise, a healthy diet, relaxation, mindfulness and reflection: when put like that, it seems so simple.

As well as self-education, organisational change is needed to combat the stress we encounter day to day. Lessons learnt from the Francis Report should help us achieve this and change the culture of not just the NHS, but of our profession. We need a healthier environment, job satisfaction and appreciation for our vocation, rather than bureaucracy and constant ‘bashing’ in the media.

Take a deep breath. Have a tea break mid morning with your practice team. Ask your colleague how he or she is doing; and if they ask you the same back, reply honestly. Remember the saying, ‘Physician, heal thyself’. How are we to help others, if we don’t heal ourselves first?

Dr Sarah Khan is a GP in Hertfordshire and co-founder of Healing Doctors CIC.

Readers' comments (14)

  • I am totally burnt out and I haven't even finished my Gp training. 2 years of brutal SHO work involving set of nights every month (plus an averages of a weekend long shifts once a month ) followed by a year of working 12 hour Gp reg days whilst studying for brutal (30 per cent failure rate) membership exams. Being a GP is amazing and I love the job but I just hope that it pays off! There is much pessimism in our profession and no unity or strong voice. Just saying.

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  • Mid-morning break? What on earth is that? Dr Sarah Khan, please go back to the drawing board or reality.

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  • I don’t think a tea break is going to be enough to stop burnout ! We need a means to match demand to capacity. At the moment the GP is expected to cope with all their patients that want to be seen. Should they all want to be seen at the same time we are meant to manage that,despite it being physically impossible for one person to do this .
    We need to be backed up if we say no and we need to be able to triage those that do not need to be seen at all, without worrying about getting complaints from patients who have unreasonable expectations.

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  • Coping strategies are not much use against a malicious government.

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  • The NHS has long been an instrument of torture. I remember Fri 9am to Mon 5pm stretches [80 hours with a total of 3-4 hours sleep] , 168 hour weeks doing 2 person's jobs when a colleague in a 1;2 rota went on holiday. Overtime rates at 30 pence an hour. We burnout because we need arithmetic in medicine. This is the fundamental core function the BMA does not do. How many hours is it safe to work, how many patients is it safe to see, how long can any doctor work without break ? Consultants in many hospitals here in NI and elsewhere in the UK still work those 80/ 168 hours continuosly on call [ supposedly] when in reality they are in hospital. GP have no restriction in numbers they must see in a day. We need health and safety. Where are the Royal colleges and the BMA. I am certain we doctors can work sensible hours without burnout.

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  • Doctors are denied membership of the human race.

    We are not allowed to have a reasonable work life balance so we can be physically and mentally healthy .

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  • Read sarah's website: 'She is now a Portfolio GP. She also Editor of Medical Woman, the Medical Women's Federation magazine. She is LMC representative for Hertfordshire and sits on her local commissioning board'.
    So in reality you have coped with stress by avoiding patients and diversifying your income away from mainline GP. You clearly have little concept that the BMA defines GP contract to see all patients who are ill or belive thmselves to be ill', ie there is uncapped demand which is unmanageable, with diminishing resources and rising targets which are impossible to meet and medically often inappropriate. if you could change that at an LMC level that would be a useful contribution, rather than the advice of avoiding biscuits and crisps on your website.
    GP burnout would cease if we were left to see patients and do what is medically needed, with the protection of an NHS which would allow us to turn away all the inappropriate attendees.
    I took 3 GP registrars on OOH over Xmas. 2 have already got jobs abroad. Out of interest Sarah, do you do a reasonable contribution to OOH given you appear to do little daytime GP

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  • I agree with all those things you identified (relaxation etc). The problem remains one of time. Yes, do as I preach but do I have 30 spare minutes a day to get a bit of exercise? It'd be great if I did. Might get a chance to have a sandwich and a cup of tea as well. I feel exhausted and I haven't finished my training yet. It gets better, right?

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  • 20+ years of GP - if the enthusiasm of 'youth' helped in the early years the constant change, tick boxing, patient over-expectation and media attacks have ground me down to the point that I'm looking forward to (? early) retirement as I don't feel I have any extra to give and my resilience is at an all time low. If I do have any advice for a long career it would be pace yourself and not take on too much to early - I set up a practice, developed a new practice building, became a GP trainer and sat on every committee I was asked to as well as being on the local PCG board (shows my age!) - probably too much too soon and 'burnout' was probably predictable in hindsight. Being self employed and an employer just adds to the stress with take home pay a 'moveable feast' (or famine when the rules change.) I have also found it increasingly lonely being so often in a 1:1 consultation - how I wish for those team ward rounds to share stuff!
    Not sure what the ideal would be, just know it's not what I've got!!!!

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  • Burn out among dedicated professionals like ourselves has to do with escalating workloads, increasing and unrealistic demands, fear of litigation and failure, inadequate resources and lack of control. We cannot simply say we are working too hard or too much. We must define what too hard is- Is that 35+ patients a day, 100 prescriptions, 60 blood tests, 10 phone calls, 40 letters, 3 home visits 10 miles away ? If we do not define this in simple mathematical terms, there is no meaning to anyone outside what we mean. They think we cannot get 18 holes of golf between surgeries. Why are there no benchmarks ? How can anyone judge if we are a] lazy, overpaid layabouts or b] pushed to limits beyond endurance. We need numbers, so we can all be evaluated, appraised and re-validated. Why this reluctance on the BMA and RCGP to put numbers down?

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