GPs are twice as likely to suffer stress and psychiatric exhaustion than the general population. Dr John Wynn-Jones looks at where you can turn to for help.
General practice is a hard taskmaster. Many studies show that GPs have levels of stress and psychiatric morbidity running at twice that of the general population.
Two studies in the 1990s showed nearly half of GPs suffering from probable borderline to severe anxiety and a quarter showing signs of borderline depression. Doctors also exhibit high levels of alcohol and substance addiction.
This doesn’t just affect us. Our spouses also show higher levels of mental morbidity. Doctors who are in trouble can also have a significant negative effect on their practice dynamics and their partnerships.
The new GMS contract was introduced when the profession warned of a manpower crisis with GPs reporting higher than ever levels of stress and burnout. What started out as a move to liberate GPs from chronically high workloads, for many ended with disempowered individuals drowning in bureaucratic paperwork and micro-management.
No wonder I hear more and more reports of GPs suffering ‘burn-out’. Mateen and Dorji in Lancet in 2009 defined burnout as ‘an experience of physical, emotional and mental exhaustion, caused by long-term involvement in situations that are emotionally demanding’ – sound familiar?
I was one of those GPs who experienced ‘burn out’ and was forced to retire after 36 years of medicine earlier this year. It has been a slow recovery.
Retirement has given me a new perspective on my career in general practice. I would not have changed my choice for the world, but there are things I wish I had done differently.
This experience has led to me to believe that general practice needs to look after itself better. We have to restore our self-belief and grasp back the initiative from the managers and the accountants.
Governments will continue to pursue change for change’s sake, but we can change the way we work and address the interface between our work environment and ourselves.
A range of studies suggest preventative measures such as better teamwork, improved practice systems, career counselling, coaching can help. Perhaps we also need to delve a little deeper, be honest and ask ourselves why we are doing this and what do we want to gain from our roles as GPs.
We teach medical students to manage distressed patients but we do nothing to prepare them for their own stress later in their careers. Relaxation, stress management and Mindfulness should become core elements of the undergraduate curriculum. Jon Kabat-Zinn’s book ‘Full Catastrophe Living’ should be on the shelf of most aspiring young doctors.
Many GPs find themselves locked in partnerships, asset rich but relatively cash poor, but this is changing. Spending 30 years in one practice will no longer be the norm, with an increase in the number of salaried posts resulting in a more flexible and mobile workforce.
I am aware of many colleagues who have gone part time and benefited as a result from an improved work-life balance.
A number of GPs have gone one step further by taking a career break, working in a different health system in another part of the world. I have recently been working with an Irish company called Locumotion, which offers opportunities for career breaks and assists GPs who would like to work in Australia.
Locumotion’s founder Ray Power is convinced that a year away working in a different health system will not only reinvigorate careers but will benefit the NHS with new fresh ideas. Some doctors will stay but the great majority return home ready to take on new challenges.
For those in despair, there is help, if you are prepared to ask for it. The Welsh Assembly provides an excellent service for GPs with its The Primary Care Support Service as does the BMA and other equally effective services (I have included a list of places you can go to for support below).
GPs are reluctant to seek help at an early stage when intervention could avoid long periods of sick leave and distress to individuals, families and partnerships. But, trust me, you must.
Dr John Wynn-Jones is president of the Institute of Rural Health, Newtown, Wales
Stressed GP Where to go for help
Welsh Primary Care Support Service: www.wales.nhs.uk/sites3/home.cfm?orgid=558
BMA resources for doctors in difficulty: www.bma.org.uk/doctors_health/d4dresourcesfordoctorsindifficulty.jsp#Stress
BMA counselling service: Tel: 08459 200169; www.bma.org.uk/doctors_health/doctorshealth.jsp?page=6
(This is an excellent 24 hour service who not only provide help for doctors but for their dependents as well!)
British Doctors and Dentists Group: National contact (via the Medical Council on Alcohol): 0207 487 4445; www.bddg.org/page.php?id=1
– Doctors for doctors: : Run by the BMA this organisation helps doctors facing difficulties due to addiction and/or mental and physical health problems. It provides one-to-one telephone and/or face-to-face discussion of problems on weekdays between 9am and 5pm. firstname.lastname@example.org; 020 7383 6739; www.bma.org.uk/doctorsfordoctors
– Doctors Support Line: Confidential, independent and anonymous service is staffed by volunteer doctors to provide peer support for doctors and medical students in the UK. It is manned for 36 hours a week by trained volunteer doctors. The Doctors Support Line is usually open Mon-Fri from 6pm until 10pm (11pm on Tuesdays). In addition, on Tuesday 9am to 2pm and Sunday 10am until 10pm. 0870 765 0001; www.doctorssupport.org
Doctors Support Network: self-help (not therapy) group for doctors who have been troubled at some stage in their lives. This includes stress, severe mental distress, burnout, depression, manic depression, psychoses, and eating disorders. The group believes that contact with and support from other doctors who have had similar experiences helps recovery. Tel: 0870 321 0642.
Email: email@example.com Website: http://www.dsn.org.uk/
Sick Doctors Trust: 24-hour, seven days a week confidential intervention and advisory service for alcohol and drug addicted doctors and their families, run by doctors for doctors. Supported by expert advisers throughout the UK, the service will arrange contact with a rehabilitation unit and/or support groups. It can also provide advocacy and support for doctors involved in proceedings before the GMC or civil courts. All calls are received by the national co-ordinator or a nominated member of the APP and responded to within 12 hours. 0870 445163; firstname.lastname@example.org; www.sick-doctors-trust.co.uk
The Primary Care Support Service: works with Primary Care Trusts and practitioners throughout Surrey, Sussex and South West London supporting the delivery of high-quality primary care to a population of around 4.3 million patients. (
The Ethical Responsibilities of Doctors towards Themselves and Their Families. BMA, London, 2004. www.bma.org.uk/ap.nsf/Content/Ethical+responsibilities+in+treating+doctors+who+are+patients
The Centre for Mindfulness Research and Practice, Bangor University: www.bangor.ac.uk/mindfulness/
The Centre for Mindfulness University of Massachusetts: www.umassmed.edu/cfm/index.aspx
Self growth: www.selfgrowth.com/experts/jon_kabatzinn.html