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Physician heal thyself



From this month, I will no longer be working as a GP within the NHS. In fact, I will no longer be a practising doctor. I’ve decided, due to the confines of the system, that working in general practice isn’t sustainable for me.

This decision hasn’t come lightly, as I love what general practice stands for and delight in the human interactions I’m privileged to be part of every time I start a consultation. No doubt the pandemic has played a role in my choice. Life slowed down, but life at work sped up. We worked in new unfamiliar ways, which, whilst they may be necessary, have and put up barriers between us and our patients. Aneurin Bevan, political father of the NHS said: ‘Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community’. He was speaking of money of course, and yet it resonates as it’s the idea of general practice supporting the communities to which we belong which I feel is slowly being eroded.

My decision is discombobulating, disorientating and uncomfortable. And yet I know it’s the right thing for me. I think I feel like I’m having an out of body experience because this kind of self-determination has been a long time coming.

The shorter version is that I decided to value myself, to put my needs front and centre and live a life true to myself. The longer version is that, sadly, the current NHS system doesn’t support clinicians to deliver a high standard of compassionate patient-focused care without sacrificing themselves along the way. The workload demands placed on individuals are unsustainable and unreasonable.

What I now realise (with great relief because I believed it for a long time) is that it’s not me who’s broken. The system is broken. There’s huge sadness in my decision because general practice, as a career, is a perfect partnership for my relational, interpersonal strengths.

I absolutely delight in the human interactions I am privileged to be part of every time I start a consultation – so much so that over recent weeks when speaking to patients I’ve thought to myself more than once: ‘You’re an idiot, why have you handed in your notice? You love this!’. The problem is that the emotional human in me struggles. She has not figured out (and in truth, has no interest in learning) how to adapt her work style to be able to connect with people on a more superficial level, which would be necessary to sustainably do all that is expected from her in a day at work.

Add the achiever in me to the way I love to cultivate relationships with patients, and it’s a dangerous combination. I’m driven to work long hours to complete everything that comes my way and invest 100% in every patient interaction (even on the days my bucket feels empty.) So, my work leads me to feel constantly overwhelmed and drained.

I made the decision to change the direction of my life one day, not too many weeks ago, whilst pottering in the greenhouse and listening to Glennon Doyle’s ‘Untamed’ on my headphones. She posed the question: ‘Would I want this for my little girl?’. I wept.

Framed like this, I instantly knew the answer, my work had to change. Truthfully, if my children came home and told me about their work being anything like mine, I would be encouraging them to move on without doubt. I would be telling them that they need to value themselves above everything else. I would be reassuring them that they had done their best in difficult circumstances and that it is honourable to put themselves and their family first. I would be telling them that work should be something we do in our lives, not something that rules our lives.

I realised that by making a decision to step away from my career now, I was showing them how to live bravely, how to value themselves and giving them permission to live their lives courageously. Making this decision is a gift to myself and my children.

I believe the current system is unsustainable and I can only hope for better in the future for my colleagues who continue the good fight. Something needs to change to prevent a mass exodus from the system. Those with power to make change need to act now to protect the most valuable asset the NHS has – its workforce.

I will be working in a new way (specifics in progress – but hopefully alongside and in partnership with general practice), with me at the helm, to support fellow humans through their life. I will be designing my own system; one in which people can flourish, community is valued and wellness (mine and my clients) is at the heart of everything I do. Watch this space. I’m excited.

Dr Lisa Finnikin is a salaried GP in Sutton Coldfield

READERS' COMMENTS [21]

IDGAF . 16 August, 2021 5:22 pm

A system which punishes you for your integrity does not deserve to have you. I felt the same and left a salaried GP role 6 months before covid struck because the situation in the NHS, if we are perfectly frank about it, even then was as described in the article.

Life happens in phases; your integrity will not let you down as your future unfolds. Best wishes.

Decorum Est 16 August, 2021 5:29 pm

That seems like a well considered, rational decision from a competent clinician, even though (or maybe because) it comes from the heart. It accurately reflects the emotions of many of your colleagues. Wishing you the best for the future and thanks for sharing.

John Graham Munro 16 August, 2021 6:05 pm

I was heartened at the beginning of your piece that you at least were heeding my advice to all others and walking away from General Practice——but no—–you are coming back as some sort of ”manager”—-that’s all we need

David Mummery 16 August, 2021 6:37 pm

Good luck Lisa ! These decisions are very difficult, but it sounds like you’ve made the right one

Simon Sherwood 16 August, 2021 8:31 pm

Best wishes . It’s never easy ( I know)

Perhaps update us in Pulse later.
There are lots of GPs out there ground down by the insane system of unlimited patient expectation , negligible resources and vicious regulators. It is much much harder than it was for my generation.

Any ideas for the youngsters to save the their sanity is welcome

Patrufini Duffy 16 August, 2021 9:37 pm

If sleepy GPs just stepped out of sheepishly signed contracts to a PCN, DES, LES and whatever other non-evidenced based gimmick is floating. Then their spine might recalibrate with their brain, and their myopia and dysthymia might happier.

Sally Watkins 16 August, 2021 11:11 pm

I wish you all the best for the future in your new role and am sorry that General Practice has lost out.

Vinci Ho 17 August, 2021 7:20 am

(1) Not exactly the same , the melancholy displayed reminded me of many of my Hong Kong indigenous fellows making a decision to leave their birthplace because of a tyranny right now.(Much worse , those fleeing Afghanistan )
(2) As I wrote before , one ramification of Covid 19 is people are ‘enlightened’ to reconsider the values of their lives , what is more important instead of others. Many times we said ,’use your head instead of your heart .’ I would say you need to use both depending on the circumstances.
(3) Absolutely respect what you have finally chosen . And perhaps this is the ‘right’ lyrics from Patty Smyth I would like to send with blessings :
‘But there’s a danger in loving somebody(something)too much
And it’s sad when you know it’s your heart you can’t trust
There’s a reason why people don’t stay where they are
Baby sometimes love just ain’t enough’
All the best 😎

Esmerelda Pulse GP Jobs User 17 August, 2021 2:36 pm

Well articulated decision, thank you for sharing. Your patients will miss your care.

Monica Stevens 17 August, 2021 6:11 pm

General Practice can only be done effectively if you have enough time . The work intensity is so insane that it can no longer be done safely.

I left because it was making me ill .

John Graham Munro 18 August, 2021 1:13 am

Monica Stevens—–my point for months now—–at least someone listens to me

A non 18 August, 2021 8:29 pm

Your article is perfectly put and I feel everything you have said. Look after yourself

Andrew Dunlop 19 August, 2021 12:22 am

Is this the cry for a once dreamt of traditional General Practice . How marvellous it seemed , where patient and GP developed a professional bond which through continuity of care gave so much , none of which could be considered “ measurable “ in the managerial sense .
Sadly it has changed beyond recognition as you suggest and would it now be a career that we would recommend for our own children ? I wonder .
I wish you well in the next chapter of your life both personally and professionally

Michael Mullineux 19 August, 2021 10:43 am

Perhaps the idealism and perfectionism so common to many of us lies at the heart of this. I have had to learn to be ‘good enough’ and to say no to survive the demands of the slow burn disintegration of NHS General Practice. Despite the daily frustrations, it is still a great job as far as I am concerned: I enjoy challenging dogma; I enjoy highlighting problems to try to facilitate change; but most of all I enjoy those patient interactions where I might have had some positive influence on outcome, even if only ‘good enough’. Best wishes for your new challenges

A non 20 August, 2021 2:51 pm

..you know what really bugs me the most when it comes to discussions about the perilous state of general practice? Its the smattering of ‘I’m all right Jack/Jackie’ GPs who pop up out of the electronic ether just to tell everyone things are just about OK where they are, they ‘still enjoy’ all the stuff everyone else does, but due to their own personal exceptional levels of Buddha like calm and personal resilience, they’re keeping their heads while all around are loosing theirs. Its folk like these, no doubt, who are continuing to negotiate, sign up to and support the ludicrous contracts we are all in bondage to, and they enable this medieval system to just about function. I am sorry to say but if you work in and support an exploitative and ultimately broken system you hold some personal responsibility for the harm that it causes. Hana Ardent’s concept of the banality of evil is worth reflecting upon. We need a better system, unless your actively involved in making that happen you are, sadly, part of the problem

Katharine Morrison 21 August, 2021 11:28 am

Yes, it is an unsustainable model of care the NHS. Best to leave now before you have cracked wide open. Many patients have never behaved reasonably regarding NHS resources but the proportion of them who play the system and the numbers who display aggressive entitlement has rocketed since we stopped night work. The GMC, BMA and RCGP need to get realistic about what can be achieved with what we have. GPs can’t be the equivalent of First World War trench soldiers and provide a decent service.

Stephen Aras 21 August, 2021 1:49 pm

What’s unsustainable is the perfectionism of much of the profession which is by definition unachievable. That the work is hard and challenging enough why put on this extra pressure? Stick with it, push for change and give yourself and the rest of the profession a break. Good enough is good enough!

John Graham Munro 22 August, 2021 12:22 pm

Why are you still registered with a license to practice Dr. Finnikin?

John Graham Munro 23 August, 2021 10:10 pm

A non——–You’re probably right——when the Moderator e-mails me to check on my mental health again, I will suggest he does not take down your comment——-it can only gladden the heart of other like-minded G.Ps

Patrufini Duffy 24 August, 2021 2:30 pm

I like that Aras – the discussion of the complex of perfectionism. It is only self-destructive.

IDGAF . 25 August, 2021 10:54 am

Perfectionism is a vapid term; the best anyone can do is to the upper limit of their ability. Every individuals’ assessment of “good enough” is also variable, and it is wise to consider that we all have stuff we don’t know, and don’t know that we don’t know. Perhaps consider, when opting to provide “good enough”, is what you are offering what you would want for your child or parent (assuming you don’t hate them)?

I know that covid has really thrown a spanner into the workings of primary care, but having been doing home visits for an urgent care/OOH provider, some of what I have seen, which may be regarded as “good enough”, is of a pitiful quality.