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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 [13]

Rachel Bennett 8 June, 2021 7:28 am

I am so sorry to hear about your troubles. As a GP with blindingly obvious physical disabilities (orthopaedic) I can’t imagine how tough it has been for you to cope with hidden disabilities.
GP land is not kind to GPs. Just as you say, “fairness” is a concept used by managers and by other GPs to try to protect themselves and their own workload.
I remember a day when a home visit request came in to see a terminally ill elderly man who lived in a house on a road going up a hill with no easy parking, his bedroom was accessed by a staircase with two tight twists. My nightmare scenario. My GP colleague on call had said, “call the hospice” but he had been discharged from their caseload. The hospice team said a GP should see him first. My colleague refused to go out. 10 hours after the call was made, because of the “stand off”, the patient had still not been seen. I ended up struggling through my physical problems, to see him and sort out his problem. It was a GP appropriate problem. Not a hospice thing.
Zero sympathy. Zero recognition I’d been forced into a painful compromise. Manager ignored my protestation. Circular email ignored, too. I hadn’t been the GP on call.
I tell myself everyone is burned out and highly protective of their own time. It makes for horrible, harsh working conditions.

Reply moderated
David jenkins 8 June, 2021 9:48 am

excellent article ! well done !

i have bronchiectasis and am running off capacity of one lung. i had to quit my high earning, single handed, rural, welsh practice in 2007 because of my health. colleagues who know my history are fine. others say “you look really well” – to which i reply “there’s nothing wrong with my face”.

i now do locums 2 days a week. life is good. you can chuck as much shit at me as you like when i’m in work, because tomorrow i’m off ! if a practice starts dumping on me regularly, or takes the piss, i simply won’t go back there. in 14 years nobody has (yet).

come to locumland one or two days a week – practices are so glad of your help. last friday i was greeted with “we’ve made you a coffee – do you want a piece of toast before we start ?”.

fees get paid on time, no qof, no silly meetings, no dealing with that shower from the PCT (or LHB in wales), no silly emails. no silly “ganfyd” requests, no silly admin, just go to work, see patients, then go home.

try it – life is good. if you don’t like it, knock it on the head !

and if you’re ever down in west wales, i’d love to buy you a pint !!

Reply moderated
Jeremy Poland 8 June, 2021 10:32 am

General practice is now a highly stressful job. This affects all GPs, more so if you have underlying health issues. This problem is largely related to our open ended workload, which isnt limited by amount or the constraints of time. Work is shovelled our way because additional work is effectively done for free. The only way round this I can see is for general practice to become salaried. You have a 4 hour shift, what do you, the managers, want me to do in this time? whatever you like, but them I leave. This approach doesnt work if it means your colleagues have to pick up the workload, but if we all worked liked this, the burden would fall on the managers who would HAVE to increase funding and the number of employees. I fear we are not quite ready for that yet, any alternatives?

Reply moderated
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