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At the heart of general practice since 1960

My own grief left me unable to see another patient  

Offering support to GP colleagues can help prevent burnout before it takes over, writes Dr Lisa Harrod-Rothwell

It was the Friday before Christmas when it happened. The last working day for many and a day of high spirits, excitement and joy. But for me, on this particular day, I knew I couldn’t do my job.

During the previous two years or so, I had continued to work while caring for my parents as each of them journeyed through terminal illnesses. Admittedly, the lack of control and flexibility over my day-to-day work load was challenging and I envied my sisters who, both in office jobs, enjoyed the liberty to postpone tasks on a ‘bad day’ to the following day. My colleagues provided the safe space to offload. At times, I had difficulty accurately evaluating risk, and so using my colleagues as ‘sounding-boards’ ensured I wasn’t becoming risk-averse in my management decisions.

Some consultations had become more emotionally demanding than usual. For example, I recall a patient informing me, ‘You’re far too young to have any idea how hard it is to contemplate losing a parent.’ Every muscle in my body tensed, my skin was on fire and the only sound I could hear was the pounding of my heart.

I was working as the chair of my local CCG, which became a place of sanctuary - somewhere I could immerse myself in working for the good of patients without the emotional investment of the doctor-patient relationship. I have since left the role to embrace other opportunities, but I still value the way it made me more resilient during this period.

As my father’s condition worsened, I continued to to drag myself out of bed every morning with the mantra: ‘Come on, Lisa, one foot in front of the other.’ I had no choice but to go on. Despite the long-term involvement in emotionally-demanding situations both personally and professionally, my head was above water and I knew that I continued to offer my patients a good, safe service.

One particular Friday morning was different.

‘Driving Home For Christmas’ was playing on the radio as I drove to work and, as the first verse turned into the chorus and images of my welcoming, warm, full of life childhood home contrasted with the empty cold shell it had become, I turned from being a kind, caring GP to an utterly exhausted twice-bereaved person who just couldn’t face another patient

I couldn’t shoulder anyone else’s problems, had nothing left to give emotionally or physically and could no longer put one foot in front of the other. For the first time, I didn’t want to see the world from a patient’s perspective. I wanted everyone to see the world from my perspective – a dark grey world.

I could feel awaited tears of grief fighting for freedom as I informed a receptionist that I had ‘run into a wall’. She scuttled out, looking confused, but within minutes a GP colleague was by my side and my surgery cancelled.

Slow burn-out

There was no ‘breakdown’, as such. Sometimes being a GP and managing the emotional demand is like a field in the rain: it can take only so much before it gets waterlogged. It had been raining in my personal and professional life for a long time and I had reached capacity.

Having a couple of weeks off to grieve for my parents was all I needed to be able to care again.  It is testament to the supportive nature of my practice that it wasn’t a work incident that caused me to feel like I could no longer go on, but a Chris Rea record. 

However, with the increasing workload, demands and diminishing morale in general practice, I know that I wasn’t the only GP feeling unable to face another patient.

It comes as no surprise that a Pulse survey has shown up to 43% of us are at high risk of burnout and one in 10 has taken time off due to stress or burnout in the last 12 months. Following the success of Pulse’s ‘Battling Burnout’ campaign, it is great news that all GPs will now be provided with occupational health support if they need it. But prevention is better than cure.

The irony is that as demands increase and morale falls, we stop doing the things that help to keep us effective and extinguish the flames of burnout before they become wild-fires that consume us.  We attempt to cope by not taking coffee breaks, saving time by not taking ‘chats’, then skipping lunch breaks too. Work begins to creep into the evenings and the next thing you know, you’re in the surgery on a Sunday night doing paperwork.

We stop making time for discussing challenging consultations and difficult decisions with colleagues. We feel under pressure to rush patients, missing out on the positive mutual reward that comes from the doctor:patient relationship. But coffee breaks, seeking and giving support to colleagues, receiving positive feedback about performance, and working in a supportive environment all help prevent burnout.

Collectively we have the power to determine the culture in which we work. Furthermore, it is within our gift to make small changes to keep us working effectively and create a mutually supportive environment. I promise that it doesn’t take long to stick your head round the door of a colleague’s room and ask how they are.  

Dr Lisa Harrod-Rothwell is a GP in Essex and former chair of a local CCG.

Reference

1 Maslach, C., Schaufeli, W.B. and Leiter, M.P. (2001) ‘Job burnout’, Annual Review of Psychology, Vol 52, No 1 pp. 397-422

Readers' comments (13)

  • Not sure we can do this collectively. As a full-time male GP with mostly full-time male partners the macho lunacy prevails. Your story very much mirrors my own. The workload creep has been rapid and overwhelming. After a 12 hour day in which I saw 39 patients, undertook 12 phone calls and numerous tasks, prescriptions queries etc etc on the way home I felt I just couldn’t cope anymore and had to stop the care. I took a few days sick leave, the first ever in 25 years and wrote to my partners explaining WE needed to make changes. The response I got was nothing short of you ‘wimp’, put up and shut up it’s the nature of the job.
    I resigned a week later and the machos are struggling to fill my ‘wimpy’ vacancy.

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  • It is a shame that there is no "GMC colleague relationship" in general practice. I know of practices in which partners do not even talk to each other. As always, resignations are hard to replace.

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  • Do we have an Union? How come all we ever get is O Dear! How does an Union allow working conditions that are so so bad that 43% are so depressed? And so many burnt out ? Is it not time to ballot? Should we stay or leave this mire?

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  • Its time more of us were honest about how we are feeling. There is a lot of bottled up tension out there... and I think there is still ill-deserved stigma attached to it, I admire Lisa for being open with her experience. It reminds me why I left the Uk. In comparison Ive just been visiting a neighbouring and gorgeous practice in Redhill on the Mornington Penninsula south of Melbourne.... very tranquil and peaceful , giant ferns outside the windows, surrounded by vineyards, and farms.... no QOF, no CCGs... just 15 minute appointments with patients who are willing to pay to be seen..... and a short walk to a lovely coffee shop where you can sit outside amongst the trees..... the contrast between it and UK practice could hardly be starker...

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  • Anon 11.13 - I am sure that this is a common situation - a lot of attention is being paid to GP recruitment with little to GP retention - no commercial company would treat its core assets as poorly as GP Partners treat one another: Emotional intelligence is I'm afraid something that General Practice does no have as a hot topic and yet the turn round is in our own hands

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  • There are partnerships and partnerships - having gone through Mum's death this year and Dad's last year I have been well supported by my colleagues - but it is a 2 way street - I got the time I needed - but whan I could work I did - in fact being at work was sometimes therapeutic. The lack of support comes from NHS England where we are actively chastised and robbed of resources even when continually "fire fighting".

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  • Firstly... "I took 2 weeks off to grieve and back to work. Just what I needed" .. Really. The amount of trauma discussed and experienced by this dear doctor Lisa is not matched by 2 weeks off!!
    We are such a coping resilient workforce that we not only diminish the level of morbidity we experience we reduce the period of care and therapeutic input we need!!! Therapists and psychologists would agree!!!
    Read pieces by Clare Gerada in the BMJ
    And then book into one of the events to listen, tell and/or share your story and make a difference at a sequence of events.
    ;)))

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  • Thank you for your honesty in writing this article

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  • think it is same amongst nurses as well, if we cant do our jobs effectively we need to go off sick, I don't think hunt values us any way

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  • During my 33 years as a F/T GP I also ran an Occ Health company, seeing many clients with "work-related stress". The cause of WRT could usually be defined by the degree to which clients could influence their workload,and control demand.
    Unless the public stops demanding that we medicalise unhappiness or being fat or any of the other inappropriate lifestyle choices we will all be driven into early retirement or ill health by the overwhelming a Nd unsustainable workload .I know how it was when I started in 1981 compared with when I retired in 2014, so it does not have to be as bad as it has become.

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