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Burnout revisited – but it’s not my fault



‘You’re doing too much’ and ‘You can’t do everything for everybody’ have often been offered to me as advice as a GP as I struggle to balance sanity and workload.

In the main, those expressing these sentiments are well-meaning colleagues, friends and family members with the best of intentions. They’re concerned for my welfare, and their intention is to allow me to protect myself from the emotional drain of my job. They want me to do a little less to make the job of being a GP manageable when I’m presented with an unmanageable workload.

Deconstructing such conversations afterwards, I find it hard not to consider the underlying, unspoken implication that the problem is mine. Am I spending too much time taking too long with each patient and caring too much? Is the way I work wrong? Am I doing it wrong? And then off I go, sliding into another shame spiral and questioning if I’m enough.

On further reflection, I now wonder whether these seemingly innocent comments are guilty of gaslighting the truth of the situation. I believe it’s my responsibility to do my absolute best for every patient who crosses
my path. Is this really being dressed up as a negative attribute?

It feels monumentally counterproductive to suggest that the reason GPs are struggling to cope with workload is intrinsically their fault and not the systemic problems, the unrealistic expectation placed on us, and the unprecedented demand.

A colleague and I keep coming back to the same question when we debrief at work: ‘What are we trying to achieve?’.

If our aim is to maximise our output as GPs, in terms of numbers of patient
interactions, the number of prescriptions reauthorised, the number of letters read and the numbers of laboratory reports reviewed as our outcome measures, then we’re very successful. Damn it, we’re champions of the world!

However, these aren’t the standards by which we as a profession or our patients judge us. It matters not one jot to the patient in front of me that I’ve slogged my guts out, not eaten or visited the bathroom that day, but have successfully completed every task assigned to me.

I believe what matters to my patient is that they have had a meaningful interaction with me, that they feel listened to and that they feel
their concerns have been addressed. It matters to me that I’m able to use my hard-earned skills as a GP to the best of my ability. I want to make sound clinical decisions for my patients, and sometimes that means allowing myself time to think about a problem, rather than dancing on the perpetual hamster wheel that a day in general practice has become.

It’s my firm belief that if we had less pressure on us, for example, in terms of appointment numbers, we would actually achieve more.

When I was considering what drives us to work as we are, I was struck by the notion that what drives our working practices currently also comes back to the fear of ‘not enough’.

What if we don’t have enough appointments? What if the easily demonstrable figures of ‘achievement’ (for example, numbers of available consultations) fall, and the assumption is a fall in productivity and work done by general practice?

I was reminded of a great book I enjoyed recently, ‘Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead’ by Brené Brown.

She suggests that scarcity is the ‘greatest cultural influence of our time”. She tells us that scarcity cultures become fearful and fixate on what we don’t have. I believe that this reduces our capacity for creativity in our working practices. The antithesis of scarcity is wholeheartedness that Brown advocates.

This requires us to be vulnerable and challenges us to be worthy as we are.
Change to current working practices, such as lengthening appointment times and allowing individual patients more time requires bravery.

No doubt, initially we would be hit by a fall in ‘capacity’ but, think of the long-term gain and the impact we could make. Should we reimagine general practice and reduce burnout?

Dr Lisa Finnikin is a salaried GP in the West Midlands

Pulse is carrying out a snapshot survey on GP workload based on GPs’ day in practice on Monday 1 March. We are asking GPs to take part to help raise awareness about the strain the profession is under.

READERS' COMMENTS [6]

Mayur Lakhani 26 February, 2021 1:34 pm

Thank you for sharing Dr Finnikin – this will resonate with many and I agree we have to ‘reimagine’ . We do need to revisit this area. There are several frameworks. One is Michael West and D Coia. They have identified the ABC of wellbeing whilst at work.

Autonomy/control – the need to have control over work lives and to act consistently with work and life values.
Belonging – the need to be connected to, cared for and caring of others in the workplace, and to feel valued, respected and supported.
Competence – the need to experience effectiveness and deliver valued outcomes, such as high-quality care.
also
Have a look at this: https://www.thehappymd.com/
It talks about a doctors vision for their ideal practice, what they actually have and what is realistic and trying to maximise the overlap/

David Mummery 26 February, 2021 8:26 pm

Thank you Lisa. A burnt out colleague once told me ‘Every contact leaves a trace’ …Locard’s principle. The same applies to GPs : every consultation leaves an emotional trace : sometimes big, sometimes small , but all leave their mark

Nigel Clark 1 March, 2021 11:59 am

Thank you Lisa. In the end you have to look after yourself first. In our underresourced practices and working lives, vocational instincts have always been undermined by workload, and are a luxury. What matters to those running the NHS, whether they be administrators or managing clinicians, is quantity of care which is more easily measured and monitored, rather than quality of care. In the end only you can demand the working style you enjoy more, such as longer appointment times. After 30 years as a full time GP Partner, now working as a GP Locum, I will now only accept 15 minute F2F appointments. Generally your employers need you, more than you need them. Though this has changed a bit with new working styles in the age of Covid, and demand varies around the country.

Shaba Nabi 1 March, 2021 2:16 pm

Lovely blog

Patrufini Duffy 2 March, 2021 8:08 pm

Leadership has let you down I am afraid. Stop these same day telephone consultations and revert back to 1-2 week waits. It is only sensible strategy, for the trivial 80% which needs a mind numbing explanation, and to reconfigure respect, self-care and use of other professionals like NHS 111, pharmacists, Hubs and plain common sense. Deconstruct everything “they” brainwashed you with, this is a ladder WHICH I am afraid has no top, and is a circle.

A non 3 March, 2021 8:42 am

Thank you, I agree with you 100%, I think many of us follow the path you are describing, we come to understand what its all about through trial and experience. In a certain sense the thoughts you’re describing are precisely what one experiences as one is actually ‘burning’ , there then comes a point after much painful reflection (along these very lines) that you come to realise your all burned out now, you no longer care and you wait for/look for or run to the exit. Look after yourself, it is not ‘wrong’ to care and do your job. The system requires you to be this way, unfortunately we are consumables. It isn’t fair on us but the system doesn’t actually care. That realisation i guess usually comes close to the point the flame goes out