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How I found a way to survive in general practice



In late 2013 I very nearly quit general practice. I had been in a partnership for just eight months, and I was exhausted and fed up. I was facing my first threat of legal action for an alleged late diagnosis, two other complaints, a falling income, and the pressures of my job as a programme director for the VTS.

I was starting to resent going to work and when I burst into tears on the phone during an unpleasant encounter I knew enough was enough. I decided I had to find ways of surviving in general practice.

My first realisation was that I had become quite isolated. I could go a whole day without seeing any of the other doctors. So I joined Tiko’s GP Group on Facebook.1 The friends I made there genuinely made me smile every day and it was like being back in the doctors’ mess. The value of talking to people regularly who don’t want something from you cannot be underestimated.

Professional judgment

The second thing I did was change how I practised. I needed to take back the control in my working life rather than practising in a way that would set me on a one-way path to burnout. The RCGP training model does not prepare you for work as a real GP, but I realised I could start to say ‘no’ and get over my fear of complaints. This subtle power shift during my consultations made a massive difference.

I learned which services are core NHS services and what we can refuse to do. This was empowering, as so much time is spent writing letters to schools or about housing or travel. I also learned to have faith in my professional judgment. If someone didn’t need a treatment, I learned to say that with confidence. For example, I had always given in and prescribed antibiotics and painkillers to people with dental infections – a classic example of covering for others’ failures and potentially harming the patient.

I could practise good medicine, have an adult conversation with the patient to make a joint decision, but ultimately, if good clinical practice did not fit with what they wanted, I now had the confidence to stick to my guns. It was revolutionary. As someone very wise put it once: ‘I shed the cardie and donned the Teflon’. Yes, I hear more remarks such as ‘well that was a waste of time’ and ‘thanks anyway’. But I haven’t had any increase in complaints and I still get thank-you cards.

The final thing I did was to give up my role in the VTS – a hard decision, because I enjoyed training. That gave me the time to set up the support group Resilient GP, with a contact I met online.2 I wanted to be part of something that could be a voice for UK GPs, providing peer support and teaching. We set up the site and social media accounts and now run courses for GPs to help them practise in a way that will enable them to avoid burnout.

A year and a half later, as anyone who follows me on Twitter knows, I am still a tired and frustrated GP, but I am back in control of my job. I can spend my time with the patients who need my medical care and get professional satisfaction. I am no longer scared of confrontation or complaints and I am willing to risk both those things to practise good medicine.

The skills I learned over the six years of the VTS job and my postgraduate qualifications in education have transferred into Resilient GP.

It gives me immense pleasure to provide peer support and education that puts people back in control of their professional lives.

As one person told us after a recent session: ‘I now feel enthusiastic about general practice for the first time ever in my career’.

There is no better feeling than knowing you have been a part of that.

Dr Stephanie de Giorgio is a GP in Kent and a co-founder of Resilient GP

References

1 Tiko’s GP Group. facebook.com/groups/tikosgpgroup

2 Resilient GP. resilientGP.org