View from the ground, by Dr Kathryn Hayman
‘Your GP has nothing left to give. She is broken.’ These were the final words of my first blog in September 2017. I had become burnt out. In my case, the cause was multifactorial, and included being a mother to two very young, wilful children. However, a significant factor was the ‘mental load’ of practising as a GP.
‘Are you part-time?’, various people would ask. I never knew how to answer. I worked 3 days per week as a GP but for about 40 hours, and my other 4 days were not restful!
Consultations start one after another at 10-minute intervals and feature an incredibly diverse range of problems, and within them we have to safely and effectively make an assessment and management plan. Medical practice is becoming more complex, and time pressure on appointments means that both patient and doctor may want to try and do as much as possible in one go. Running late results in an internal conflict between the desire to do your best for the person in front of you and the need to avoid keeping subsequent patients waiting. I often used to do a lot of follow-up tasks in my own time rather than allocating time for them, falsely believing that it would place less pressure on the system for everyone else. In short, there was too much work and too little time.
Using methods to ‘compress’ the consultation are extremely challenging as an empathetic doctor; giving people time and listening well is a major part of the therapeutic relationship, and can be a worthwhile ‘investment’. Your patient is a human being, not just a health problem, and taking a truly holistic approach is intuitive. My patients frequently say, ‘I felt like you really listened and took me seriously’. For them, this can be as important as solving the medical aspect, and for me, it is more fulfilling.
Empathy most notably impacts a GP’s wellbeing when something is causing a patient significant distress. When someone in front of me is clearly suffering, I can almost feel their pain. There are occasions when I struggle not to cry with them. Some days, a large proportion of consultations are like this. As somebody that ‘feels deeply’, this is incredibly emotionally draining.
This sensitivity extends beyond patient contact; it can also feel difficult to ‘put upon’ others, such as already hard-pressed administrative and secretarial staff. There is an instinct to try and do as much as possible yourself. A phrase commonly encountered is ‘Can you just…?’ for things like sorting out prescription issues. I always used to say ‘Yes’. In addition, I always used to go the extra mile for my colleagues, even when I wasn’t on top of my own work.
So, how do you practice ‘self-preservation’ as an empathetic GP? In simple terms, where possible, do the opposite of the above. Initially, I erroneously tried to change who I was as a doctor—which was actually quite distressing. I then realised that it was essential for my own wellbeing to remain authentic to myself and my practice. Of course, achieving this balance is easier said than done, but I actively made changes to my life to prevent a recurrence of that original burnout.
Professionally, I added a ‘catch-up’ slot after every five patients—this often just reduces lateness, but that in itself helps to reduce stress levels. I amended my working sessions, breaking up my working time to allow ‘decompression’ in between. I learned to sometimes say ‘No’ and to delegate appropriately. Also, I allocated dedicated time for follow-up work.
Outside of work, I added in a little child-free time each week—time to get some of those essential tasks done. As an introvert, this time represents a crucial period of silence and solitude. Most importantly, it is a chance to recharge. This analogy is something I have portrayed visually through a ‘self-care battery’ diagram (see Figure 1). Previously, I had been expending my energy almost completely and never replenishing it, until there was no ‘me’ left. I have realised that recharging doesn’t just mean resting, but also adding positive experiences and enjoyment and rediscovering myself.
Now, I am no longer broken; I am still an empathetic GP, but I have learnt to ‘self-care’ and ‘recharge’ to compensate.
Dr Kathryn Hayman