I am neither religious nor spiritual. Yet it is the Serenity Prayer I refer to most in times of need: ‘God, grant me the serenity to accept the things I cannot change, courage to change the things I can change, and wisdom to know the difference.’
Although I have saved my sanity, I feel huge guilt
As an educator who has indulged in extensive navel gazing, I am aware of my strengths. I know that courage, but not serenity, is one of them. So I’ve spent the past nine years as a partner trying to be courageous and change things. I’ve tried to manage patients by ensuring consistent practice policies. I’ve tried to manage demand by discouraging dependency and fostering a culture of self-care. I’ve tried to manage recruitment by diversifying the workforce and creating a supportive training environment.
But this is a battle where I am faced with weapons of mass destruction and all I have is my bow and arrow. Occasionally, my arrow may land on target, but I am exposed to a lethal and toxic environment, where eating, breathing and sleeping my struggles becomes the norm. A place where I daren’t switch off for fear of being unable to switch back on. A cocoon that may appear warm and comfortable on the outside, but is slowly destroying me on the inside.
So, because I was never going to do serenity, I moved away from courage and on to wisdom. The wisdom to realise that the contract was making me drained, cynical and depleting me of joy. And I used the courage to turn my back on it and walk away.
By the time you read this, I will no longer be a partner. The role that 10 years ago was being pursued by hundreds of applicants and I felt so proud to achieve. The role I moved cross country to undertake because it was almost impossible to secure a partnership in the South-East in 2006. In stark contrast, our practice now has unfilled vacancies for three whole-time-equivalent GPs and I know we are not alone.
So in spite of rationalising, innovating and merging, I was unable to shake off the burden I felt on a daily basis. My pessimism was malignant and insomnia the norm, as I lay in bed worrying about my business going under and having to sell my house to pay off the liabilities. There was a nausea that grew over the course of a Sunday evening and I started dreading my job and resenting my patients. The final nail in the coffin was the stark realisation that I felt anger instead of empathy when a GP colleague went off sick. That was the trigger for me to complete a burnout questionnaire; the results were so disturbing I gave notice of my partnership resignation that very evening.
Within a few weeks, people noticed how much more relaxed I looked. My brain started filling with creativity instead of anxiety. Yet although I have saved my sanity, I feel huge guilt for turning my back on the independent contractor status that I still believe to be the most efficient way of delivering primary care.
But I’ve chosen my sanity and I’ve chosen my family. Most of all, I’ve chosen life. Because life is too short and too precious to be a scapegoat for the NHS.
Dr Shaba Nabi is a GP trainer in Bristol