It is a difficult time in Australian general practice at the moment. The government has been toying with Aussie GPs by arranging to cut Medicare rebates. Instead of investing more in primary, universal health care, they are trying to devalue it and make it unsustainable. I can foresee even greater time pressure and responsibility as we try to care for our patients in fewer visits. I envisage less remuneration, with constant pressure from patients to accept a lower fee for the same good quality care.
It is at times like this this that a GP may be even more vulnerable to burnout.
What are some of the warning signs of burnout?
You may notice:
Irritability- increasing exasperation with patient demands, the critic in your head that talks back to patients becoming louder and more voluble.
Feeling empty, drained- with nothing left to give. Certainly nothing left over at the end of the day for the people that matter most; family and friends.
Compassion fatigue- Our capacity for empathy is not endless, despite what we set out believing during medical school. You may become impatient with the suffering you encounter. ‘You’ve got a sore elbow? Oh poor you. Some people have real problems!’ says the critic in your head. Meanwhile, the poor patient is actually in great discomfort and perceives you as uncaring, and the patient-doctor relationship is damaged.
Feeling like a fraud- this is quite common among sensitive, perfectionistic doctors to begin with. You may feel you are unfit to be practicing as you are ‘bound to miss something’ or somehow do the wrong thing (although in reality you are probably a very thorough and competent practitioner).
Disorganisation- feeling unable to cope with the competing demands, to juggle paperwork, patients, phonecalls, getting to daycare pick up on time, getting more and more frazzled with no relief in sight… Being an organised GP is hard at the best of times!
Signs such as those above may indicate you need a break, more support, or a change in the way you practice.
What are the signs you watch for in yourself, that tell you it’s time for a holiday, (or a career change)?
Wouldn’t we all love to be the reliable, full time country doc, there in his chair for generations to come, always available, always kind, competent and zen? However, not all of us can do that, and that’s ok. For some of us, this is just not a sustainable life.
I don’t think I can always be that doctor. I need to work out, and then be, the kind of doctor I really am.
What to do if you are burnt out:
Take time off- this is essential. How much? Enough.
Physical exercise. Intense, heart pumping exercise is a great treatment for anxiety. It also helps regulate your mood and manage stress.
Clean habits- good food in sensible portions, quality sleep. Reduce alcohol.
Peer support. This is vital. (My study group has reformed, years after our exams, to enjoy the support that was the best part of our study sessions. We hold ‘study group’ once a month but for the purposes of peer review, friendship and case discussion. It is fantastic).
Watch how you practice. When you start back at work, go slow and take your time. Don’t overload yourself in the attempt to catch up. (‘None of us are indispensible’, a mentor said to me recently, and it is good to remember this. There are other doctors there to care for our patients when we can’t be there).
Remember, it is the patient’s responsibility in the end, to prioritise their own health. Your job is to give them the best advice and care you can, but it is entirely up to them whether to take that advice and accept that care. This can be difficult, especially when the medical profession is made to feel legally liable for everything our patients do. Being on the frontline of healthcare as a GP is particularly tough as we are the first and often the last port of call for all aspects of patient health.
As always, I welcome all of your insights and suggestions for avoiding and managing burnout, a common problem in medicine and other caring professions.