A Burnt Out Case

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.

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7 comments

  1. I totally relate to your words and you’ve summarised how I felt when I worked in General Practice. I hope you do find a way to look after yourself and get some balance back. Doctors are not superhuman, although I think some people expect them to be …

    I’m currently writing an article on ‘Why I Walked Away From Medicine’ and you’ve just encapsulated one of the reasons. I felt guilty, too, about my lack of compassion for my patients at time, and not always holding them in ‘unconditional positive regard’. There are people for whom it is very hard to find compassion, and, to be completely honest, I think there’s a lot of pressure on doctors to be above feelings like annoyance at or dislike of our patients, when, really, there are people who are annoying and dislikable out there. I felt guilty about the way I thought of some of my heartsink patients, or how I wanted to tell someone requesting days (note plural) off work for a minor ailment when I was at work after being up most of the night with a sick child or only because I was dosed up on cold ‘n flu tablets.

    I left General Practice because I couldn’t uphold ‘unconditional positive regard’ for all my patients and moved into the area of breast cancer, where I worked for seven years. Despite constantly giving bad news and working with people with cancer, some of whom were young and didn’t survive, I found it much easier than General Practice.

    1. Thank you for your comment. You are absolutely spot on- some people do expect doctors to be super human, infallible and constant, immune to frustration and non-reactive in the face of their disdain, demands and sometimes tantrums. I am not sure I am cut out for general practice and am considering different long term options myself, so I eagerly await your article.

  2. I have a couple of tips (a young player myself so take with that in mind) – learnt mainly from years of noting the kind of doctor I didn’t want to become and trying to work out why the happy (as in generally pleasant as well as pleasant to be around) docs were. We set ourselves up to work less than my senior peers do. Less work equals more sleep equals happier doctors.
    You do need to work “enough” though. No point doing 1 day a week if it still equals a day a week of following up results and being upset you can’t follow up the patients who need it. More satisfying to work enough to provide a standard of care where you can follow through. I have a few core other things I like to do (as do you) and I schedule them in (not a perfect system but better than just hoping i get to go for a run this week). Realise it’s ok to not spend every available minute with your family. Kids grow up quickly but not THAT quickly. We also live for the next holiday. Rule of thumb is at least one “big” holiday (a couple of weeks) a year and 3 or 4 short breaks (long weekend in Mudgee?) (not referenced but I can find one if you need it!). The other one you are already doing which is the giving back – teach, volunteerā€¦medical is easier but not essential.
    That said, I had 2 weeks off at xmas and when I went back I was so grumpy I wanted to throw my uncomfortable nasty shoes at the dreadful patients. Seemed an endless barrage of people in thongs who were still on holidays or who were late to appointments because they fell asleep on the couch. NOT FAIR!!!

    1. Thanks for the thoughtful and sage advice. It is so true that the things we were relieved to get away from on a holiday are often waiting for us, unchanged, when we return! I am still half on holidays myself and probably looking infuriatringly relaxed and tanned, however always manage to make my appointments. There’s no excuse! They should pay for the extra time they put you back, I suggest!

  3. I have been meaning to ‘write’ to you all to let you know that I ended up modifying my original post. I was advised to re-consider sharing such personal information in a public forum and I chose to take that advice for now. Though stigma should not exist, it does, and though doctors are human, many still expect us not to be. I think your comments are still fitting and valid, though if any of you would like to retract your comments considering I later changed the post, please let me know! Apologies for the belated notice.

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