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.