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Why, as an autistic GP, I’m leaving the profession this month


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Like all major events, the pandemic has sharply focused many of us as to where our priorities lie. How we want to spend our careers and working lives. The challenges of the pandemic, with rapid flexing of general practice towards more remote consulting, made working as a GP more accessible for me personally.

But these gains are quickly wiped away by GPs themselves who, apparently, view remote care as ‘not proper medicine’. These retrograde moves are indicative of the ‘do more’ (even at your own expense) culture in our profession, which has led me to resign my salaried role.  I’ll be leaving at the end of this month. I’m not sure when I’ll be back, or indeed ‘if’.

I’ve been a GP for more than ten years – a doctor, more than 20. In that time, understandably, nothing has focused our attention on the NHS like Covid. General practice has again proved itself to be the crucial community cornerstone of the health service. It’s doing more than ever; absorbing more and more work from secondary care, while managing to see and speak to 10% of the nation every day and deliver a world-leading vaccination campaign.

Despite this escalating workload, the new normal of delivering appointments remotely and occasionally working from home meant that I had more energy – energy that I hadn’t sunk into managing my physicality in the presence of other humans or tolerating an environment that drained me.

Now, with lockdown restrictions easing and a call to ‘unlock the doors’ (they were never locked!) the impending end of the pandemic has made it clear that general practice is a difficult environment for me to work in. One that my autistic brain can no longer bend itself around.

I was diagnosed with autism and ADHD in 2019, six months before the pandemic broke. I had been unlearning all my misapprehensions about these diagnoses for a year by that point and, although not incompatible with a career in medicine, my diagnoses illuminated why I find certain environments unerringly draining.

The energy-suck – as I call it – extends beyond merely the physical environment – bright, fluorescent lights; noise-amplifying hard surfaces; bright white paint – to more ephemeral concerns, such as the working culture or practices. Not least, people claiming one thing, and then doing another. Wringing their hands over workload and wellbeing but expecting colleagues to ‘just do it’ illustrates – to me – the disconnect between caring for patients and caring about ourselves.

Perhaps this is unfair. In fact, I’m sure that most GPs do care about other GPs – but mostly in an abstract sense. When it comes down to the practical caring by, for example, arranging a different, more personalised way to work, this caring is limited by blustery concerns about ‘fairness’ that really boil down to ‘how it affects me’. I must play my trump card of autism and disability to get what I need, rather than it being an ordinary part of negotiating a role.

Of course, this inflexibility reflects how overstretched most practices are. But again, to me, this doesn’t compute. Mostly, GPs own and run practices. Surely they can determine how, and how much, is done. But there seems to be a desire to never say no, even if it oversteps the bounds of reasonableness and capacity.

By absorbing this for so many years, the work has been effectively hidden, leading to ten or 12-hour days for colleagues contracted for far fewer. Coming in early to get ahead of it. Work extending into family time. In the end, it is this that is driving my departure. The culture that has no boundaries when it comes to patient care. My rejection of it, judged by colleagues as a moral failing. Uncaring. Selfish. Not a ‘proper’ GP. My worst fear: They’ll blame it on my autism.

The disadvantage of having an invisible disability is that people can’t easily see it. Perhaps it ‘looks’ like I’m being work-shy. Or worse, I disclose my autism and people think: ‘not cut out for GP’. This is a lazy assumption made by ignorant, exhausted people. The unlikely advantage, however, is that I no longer blame myself for having limited energy to expend at work.

I’m much more aware of my limits and am protective of myself to the extent of removing myself from places I can’t fit.

The current double-bind in general practice – of being both the cure to all ills and unable to take care of its own – makes it untenable for me right now.

For me, working arrangements can be a bit more fragile. Each time a new proposal is made, it’s a painful process to renegotiate what I need to remain engaged with working as a GP. So I’m relieved that my GP job ends in a few weeks. But NHS England’s latest SOP will make it even less likely that I’ll ever be able to go back.

A GP in England who wishes to remain anonymous

READERS' COMMENTS [10]

John Graham Munro 8 June, 2021 11:42 am

David Jenkins——Couldn’t agree more——I’ve been telling that to my colleagues for years——-but they’d rather work themselves silly

Decorum Est 8 June, 2021 1:49 pm

Excellent article.
‘Medicine selects for autistic traits. High-achieving autistic individuals are intensely focused perfectionists with great attention to detail and often have particular strengths in pattern recognition, all skills which are clearly advantageous in medicine. Autistic people are often creative thinkers and problem solvers, and contrary to popular assumptions have been shown to exhibit high degrees of empathy.’
(ac.uk/news/doctor-can-autistic-doctor)
There are lots of roles in primary care where your contribution will be valued and you can control and limit your input. Regardless of your decision, all the best for the future.

Monica Stevens 8 June, 2021 6:22 pm

The strengths of perfectionism lead to burnout because it is impossible to do the job well in a 10 minute slot. This leads to a lot of unhappy doctors.

We need more GPs so we can have longer appointments so we can deal with our patients effectively. It will be cheaper in the long run. Alas I suspect it is too late as we are about to face a tsunami ot early retirements which will make those left have to work even more intensely , if that is possiblle.

Mark Semmens 8 June, 2021 7:36 pm

Doctors should take a look at the way the airline industry looks after their pilots. With ultimate responsibility for others’ lives they are regularly tested both physically and psychologically and have rigid working patterns. We’ve got a long long way to go !!

Good luck and well done for taking the best path for you ., hope a lot of our colleagues read this.

Martin von Fragstein 9 June, 2021 1:33 pm

This is a stunning statement; If we don’t ask if our neighbour is ok, is ignorance a proper defence? Our strength as healers comes from our own wounds and struggles, which is rarely acknowledged.

Well done on writing this piece and I wish you all the best.

Luqman Rajput 9 June, 2021 6:17 pm

Excellent article.
I think that general practice/ wider NHS still got so much to learn. Just because you had some resilience training and can access an app or counselling service does not mean you won’t struggle. Expectations of performance over and above what you can sustain is concerning.
Just doesn’t feel right ?

Andy Whitfield 10 June, 2021 11:10 am

Very well written and the strong message will resonate with many of us.

Patrufini Duffy 10 June, 2021 12:07 pm

They marked you by checklists. And you were forced into roboticism. Competition. Hierarchy. Unappreciated soldiers. No place to be human in it all. Just a matrix, rota, and delivery machine. Take your watch off. Throw your water bottle away. No lunch. No toileting. Make publications. Teach. Study. Whistleblow your colleagues. It is a toxic place if you look at it. Safeguarding training – is never about you. Perfectionism and altruism are admirable but combustible nearby. That is what runs the NHS, your good will. That invisible ether. Thumbs up.

John Graham Munro 10 June, 2021 4:10 pm

At least one G.P. has the sense to get out now

C Ovid 10 June, 2021 8:40 pm

nb