Writing this article makes me feel like the pot calling the proverbial kettle. I am probably not the best person to talk about having a sensible work/life balance – given that since taking over as chair of the RCGP I have worked 16-hour days most days of the week, crawling into bed exhausted most nights at midnight, only to rise again at 5am.
My work/life balance is, at present, non-existent. Work is my life and my life is work. Or, as a Twitter friend @EA_Holmes put it: ‘I don’t like the implication that work isn’t life… Hard to find a better term other than simply “balance”‘.
But it is the combination of lack of support and perceived high workload that, according to a longitudinal study of UK doctors, leads to the greatest level of burnout. To paraphrase Freud, ‘love and work are the cornerstones of our humanness’. To stay mentally healthy, you need both bases.
By love, I take Freud to mean relationship networks – friends, family and partners. People who you can laugh with, cry with, relax with or just simply sit with – relationships.
Do not skimp on forming these. If you’re a young GP, stay in touch with your VTS group or MRCGP revision group. You will all be more or less at the same stage of your career – for example, juggling first-time parenthood with starting a new job. Even if you feel tired, go and see your friends, use social networking sites, tell your mother how you feel. Go to a film. Spend time having coffee with your sister. Offload, debrief, reflect.
I began in medicine at a time when space to reflect was built into the working week, whether this was through GP trainee or young practitioner groups, or at practice level with the weekly team meeting, an opportunity for clinicians working in the practice to get together to listen and learn and discuss our feelings about patients.
Many of these groups used the Balint formula, but any space for reflection, un-minuted, is helpful to think, share and learn. Every so often, as busy professionals, we need to step back and consider how we handle the load of sadness, grief and stress that we encounter in our everyday work.
To me, ‘work’ means structure, and a purpose to our life. For doctors, our work is never just ‘business’. We become doctors because we want to care for people.
Our pride in our work is our strongest defence, boosting our self-esteem and preventing burnout, but sometimes this is not enough.
Other things get in the way: arguments with colleagues, workload, a patient complaint. Sometimes the very characteristics that make us good doctors – obsessive attention to detail, conscientiousness, altruism, self-sacrifice – prevent us from realising that we need to stop work. Warning signs, such as constantly staying late, taking work home, needing that glass of wine to relax at the end of the day, rowing with loved ones, all need to be taken seriously. If necessary, we need to seek professional help.
Doctors are notoriously bad at recognising when things are beginning to go wrong for them. Work is usually the last part of life to go – holidays, relationships and good health crumble well before our practice suffers.
This is why it is so important to spot when work is getting in the way, and becoming as much a part of the problem as the solution. A good article, ‘How to handle stress and look after your mental health’,1 gives practical advice about avoiding the stressors that can lead to burnout.
The advice includes finding a support network early in your career, adopting regular self-care practices such as reducing alcohol consumption and taking regular exercise, and putting aside time for family and friends.
When all fails, and work intrudes into your life, remember to take stock. Ask yourself: ‘What am I achieving from this? Do I enjoy what I am doing?’
In the end we all make choices. Some of us choose to work too hard. Just make sure that the other base in your life is covered – your love.
Dr Clare Gerada is chair of the RCGP and a GP in Kennington, south London. She is on Twitter at @clarercgp