View from the ground, by Dr Vasumathy Sivarajasingam

Sivarajasingam_ Vasumathy_web

Dr Vasumathy Sivarajasingam

Throughout the 20 years of my working life as a GP, many of my colleagues in primary care have been exposed to increasing workloads, high patient expectations, and litigation, which can lead to escalating levels of stress, burnout, and low morale. GPs and practice staff have recently faced growing anti-GP sentiments, despite working tirelessly and embracing the new challenges imposed by the COVID-19 pandemic. Under these pressures, how can we survive and thrive in our professional lives?

We need to develop strategies to cope with the potential harmful effects on our mental and physical health, in addition to sustaining the primary care workforce and improving patient care. To me, promoting and practising resilience seems to be the key approach. This led me to review articles online, watch TED (technology, entertainment, and design) talks, and attend webinars, in the hope of developing strategies that I can follow and share, to ensure the longevity of my professional life.

Resilience can be defined as the ability of an individual to adapt to and manage stress and adversity. Anyone can cultivate resilience—it is an evolving process, which varies with circumstances, knowledge, skills, and attitudes. Resilience is an essential quality for the primary care team, especially GPs; failure to cope well with stress can be detrimental to our health and wellbeing. If we are to maintain compassion and manage complex, day-to-day clinical and managerial situations successfully, we need to think positively, embrace challenges, and socially connect.

We can exercise a number of techniques to strengthen resilience at work, such as keeping a journal or practising meditation. Below are some strategies I have found valuable in building my own resilience at work.

  1. Cherish social support and interaction—having caring and supportive relationships both inside and outside our family are vital. By surrounding ourselves with people who motivate, inspire, and challenge us, we can build a supportive network that drives us towards where we want to be.
  2. Treat setbacks and failures as a learning process—use challenges or disagreements as opportunities to acquire skills and build achievements.
  3. Accept that change is part of life—learn to deal with change, because how we interpret and respond to events has a big impact on how stressful we find them.
  4. Keep things in perspective—place challenging events in the broader context of lifelong personal development.
  5. Build self-confidence and know your limits—trust your instincts, and practise delegating and sharing responsibilities.
  6. Celebrate success stories and enjoy accomplishments—evaluate what went well and congratulate yourself at the end of each day.
  7. Develop realistic life goals—try to do something each day to move towards them.
  8. Have a positive attitude—maintain a hopeful and optimistic outlook, and replace negative thoughts with positive ones.
  9. Be compassionate to yourself and others—self-compassion focuses on being mindful, kind, and forgiving, with the aim of reducing harsh self-criticism and acknowledging our ‘human nature’ in a manner that is ultimately strengthening.
  10. Spend time alone and reflect—slow and gradual behavioural changes are sustainable.
  11. Create a legacy—remind yourself what you wish to accomplish by working, and ponder on the legacy you desire to leave as a result of your work.
  12. Practise good self-care—eating a healthy and balanced diet, exercising, and getting enough sleep play a crucial role in providing the right headspace to tackle daily pressures, as well as unforeseen upheavals.

For the practice, staff resilience is important in order to maintain the quality and sustainability of services. Evidence suggests that resilient doctors deliver higher quality care, and are less prone to medication errors, becoming sick, or leaving practice, thus reducing costs to the NHS.1 From a personal perspective, resilience enhances our emotional and psychological wellbeing, as well as our home and work lives. It assists in reducing burnout, increasing empathy and compassion, and improving physical and mental health.

Resilience training should focus on mindfulness or meditation, yoga, breathing exercises, lifestyle advice on exercise and diet, and general guidance on stress management. This could include providing information on the physiological mechanisms of stress, and how to manage practical issues that can cause stress. The idea is to not just focus on individual factors, but to also take into account organisational issues, to reduce stress in the practice.

Integrating resilience workshops within undergraduate training and in individual practices would be an ideal way to promote resilience in primary care. I am confident that this would be a positive step towards improving job satisfaction, enhancing morale, and reducing burnout among GPs and practice staff, which would also help to enhance personal wellbeing and relationships among the whole team, and maintain the quality and safety of care for patients.

Dr Vasumathy Sivarajasingam

GP Partner, Hillview Surgery, West London

Reference

  1. Cheshire A, Hughes J, Lewith G et al. GPs’ perceptions of resilience training: a qualitative study. Br J Gen Pract 2017; 67 (663): e709–e715.

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