I qualified in 1978 and became a GP in Twickenham. As a result of ‘maladaptive perfectionism’, I wore myself into the ground and had a severe episode of depression in 1986 that required six months off work. In 1997, I started noticing an increasing fatigue, weariness and negativity with my GP work, together with a frustration that I was able to identify as resulting from spending nearly all my time addressing downstream ill-health. What I really wanted to be doing was tackling the causes upstream– the ‘John Snow’ spirit I guess. I could also feel my depression increasingly bumping around in the background again. Having been walked by my ‘black dog’ frequently enough to be familiar with its bark, was able to delineate it from the features of increasing burnout that I recognised from my involvement with the mental health and wellbeing of doctors since 1990.
Serious issues in life are better addressed sooner rather than later, so, with advice from the Deanery, I took a sabbatical in 1998.
I buried myself eagerly, and with near-instant relief, in all the issues that I had imagined myself doing whilst listening to patients - many of whom I knew so well I could have undertaken consultations in their absence.
I became a trustee and later chair of the Depression Alliance, founded the Primary Care in Mental Health group that became the charity Primhe, set up the National Depression Training Centre in Northampton and got stuck in to running workshops and events to help doctors – especially GPs and psychiatrists, to focus on their own health and wellbeing and to appreciate its importance to their lives and work.
We need to practice what we preach and so, in 1999, I took early retirement on medical grounds - realising that I had to address the Snow spirit within.
It was clear to me that I had only left a general practice in Twickenham, but not general practice itself. Whilst working extremely hard, I did not feel drained, fatigued or numb in the way that I did when I retired as a GP.
I did not revoke my license to practice until 2010, and spent many hours counselling doctors and other people about ‘matters mental’. I still do, whilst making it clear that I am still ‘in good standing’ and give my advice as someone with lived experience and medical training.
I have also learned the truth of the saying, ‘you can take the man out of medicine, but you cannot take medicine out of the man’. Doctors are ‘wired’ according to the same principles as every other person and the fundamental things apply to all of us too.
Whatever your state of emotion and mind, please be assured that there is much help near to hand and the first step, as you would advise any of your patients, is to seek it out as soon as possible. I can tell you with confidence that, if you prioritise your health and wellbeing and that of those you love and care for, you will make the right decisions and, rest assured, whatever you decide to do next, there is plenty to do – even if it is simply to have an assured rest.
The need for change
This is all not just about us as individuals either, but the systems in which we all work. The Francis Report gives us all a clear mandate and permissions to be tough on the causes ofintimidation, bullying, monotony, mediocrity, managerialism, industrialisation and commodification. Alienation from our values and disconnection from our work and each other are evidence-based recipes for disaster.
GPs in England, as commissioners, could be prioritising those issues that will positively enable the deconstruction of uncaring, uncompassionate and cyborgish practices, as well as public health interventions that address the causes of so much ‘illth’ that individual GPs are pretty powerless to address as individuals beyond endless QOFing and benevolent sanctimony.
Further, optimal health outcomes and ‘efficiencies’ will be constantly thwarted by sick professionals and practices. Such issues need to be tackled not just by being ‘high on the list’, but by being the first on it.
Pulse’s survey on burnout launches on the back of a shared experience of burnout and depression, and the continuing and sustained need to address the health and wellbeing of those charged with the health of the public.
Dr Chris Manning runs Upstream Health Limited, was the founder of Primhe and worked as a GP between 1978 and 1999.