A really inspiring post by Dr Kate Dyerson, a GP principal in Berkshire, who recently went through some struggles of her own. By taking action, she has come out the other side stronger. And thriving.
Following on from the stories that other GPs have been brave enough to post I thought it might be time to add my own voice, especially as I think I may have come through to the other side and I am back working as a GP, mostly happily.
After a series of adverse events at work and home, I started 2016 fairly low. At work I started to feel overwhelmed with the volume of work, the sheer inanity of a lot of the paperwork and the need to reflect, evidence and log virtually everything to meet the needs of revalidation and CQC.
I started to feel irritated with the requests for “To whom it may concern” letters for ballet exams, postponed work trips and the like. And annoyed with yet another parent who felt that one day of vomiting in a 6-year old required my urgent attention. My appraisal seemed to be about providing chits of paper to show what courses I had been on and which audit I could dream up to tick that infernal box!
I have felt this way before. After both my children were born, I had post-natal depression so I knew that I needed some help.
We were about to go away and I thought that some SSRI and 2 weeks in the sun would fix it all. My GP was away but his locum turned out to be a retired GP with lots of good, old fashioned advice and whilst he gave me my citalopram, he also asked some pertinent questions about my ability to work safely.
After I returned from the trip, nothing had changed.
My mood felt ok, but to my surprise, physically I did not. That dragging feeling of walking through treacle seemed to be with me constantly. I desperately wanted to sleep all day long. I felt like I had jet lag and that really made surgeries hard work.
By June I had been back to the GP three times and I finally conceded I needed a rest.
What I thought would be a two-week break turned into six weeks off. I can’t remember what I did during that time but I certainly wasn’t bored! I slept, gardened, took the dog for walks, saw friends for coffee and relaxed. The children loved it and so did my husband. ”Grumpy Mummy” went away and” Happy Mummy” returned.
When I returned to work, I did a month of half days. I had 18 sessions with a private psychologist at huge expense, but she helped me delve into why this had happened and, more importantly, how I could prevent it from happening again.
What still puzzles me is why I did not come out of work sooner.
What is it about GPs (and sorry to say female GPs in particular) that makes us feel we have to keep going? Is it combining work and family that does it? If tea has to be prepared and the washing done regardless of how much energy you have, does work become the same? Do we stop being able to separate the essential aspects of life from those that should give us pleasure and stimulate us?
Medics are a tough bunch. We learn the hard way that dissolving in tears at 3am does not make the venflon go in any easier. Nor will your SHO (sorry, out of date with correct terms) come to your rescue so you keep going. Eventually you become someone who sees failure to cope as an extra burden for your colleagues and something to be avoided.
Early on, after the children were born, a GP (a female as it happens) commented that childcare must fit around my commitment to the role and not the other way around. I have carried this since, with work becoming first priority, family and friends second.
I don’t think there is a distinction for me in whether it’s a physical problem or a mental one. I felt just as guilty taking a week off after a minor op as I did this summer. I don’t recall being cross or upset when my partners have been ill, so why did I assume they would be upset with me?
Whilst I was talking to the psychologist she helped me appreciate, was that partnered with all the subtle pressures of being a doctor, are the personality traits running through us: ‘conscientious’, ‘hard working’, ‘reserved ‘, ‘dedicated’ and ‘determined’. All words used over the years on my school reports and assessments. All fabulous qualities in producing a GP who cares, takes her time, gets to the root of the problem and does her job really well.
But the other side is that these also produce anxiety, fear of failure, fear of being disliked if we say no and fear that our patients will stop loving us if we do not meet their expectations. The down side of ‘conscientious’ is that doing our job well is where we get validation.
If partying isn’t your thing and adventurous challenges don’t do it for you then being told “You are so reassuring doctor”, “I know its 3 weeks to see you, but it’s worth it”, and “You are definitely the best doctor here” are magic words. They act like a drug feeding our insecure souls. No wonder we fall apart and no wonder we can’t ask for help.
Reading one of Kate’s earlier blogs struck a chord. She talked about whether “resilience “ was a good thing. To me, it’s a hateful word that implies that a good doctor would recognise her difficulties, fix them and come back stronger. Hopeless.
So, what changes have I made?
Some were tiny and some huge but all have made a difference to me, and my ability to enjoy my work.
1. I now shut my door when doing paperwork.
Really? Who knew that that would work but it does. No one pops their head around for a quick chat, a sneaky request or prescription. I stop for lunch, eaten in the coffee room away from the screen, for those chances to catch-up and chat instead. In doing so I have efficient, quiet time alone to do the admin. And less heartburn!
2. I have changed my hours.
My two long days were too much, so on one, I finish at 2.30pm to collect my daughter from school and have a relaxed afternoon being a mum and housewife. In-lieu, I nip in on my old day off and do a 2-hour surgery and have another free afternoon. Whilst I am now in four days of five, I feel much less tired mid- week, and mentally I love walking away early.
3. My Friday duty-day is now triaged
I phone all patients who want an appointment that day. I have cut down by half the numbers of patients coming in. I safely advise those who have minor illness, a sick note request or medication queries without them all pouring through my door. I have, in effect, taken control back and stopped the virtual open access that we had. It’s an amazing feeling.
4. I am learning to say ‘No’
My counsellor spent ages with me looking at why I can’t say no. It’s deep rooted in 1970’s parenting, mixed with a conscientious nature, a desire to be liked and a neediness that I still don’t much care for in myself.
I have started to say no, gently, kindly and appropriately. And nothing bad has happened. Patients have accepted that sometimes there is just no way around it. And the staff have also accepted it, particularly when they know they should not have asked in the first place.
It’s not about being difficult or obstructive. Just honest about what is useful for me to do, and what is not.
5. I no longer apologise if I cannot do something.
If I have a meeting to attend as a partner, I don’t need to apologise for being unable to help with visits that day. I don’t need to feel guilty.
I have found it rather liberating to free my own mind from the guilt. And I accept that it is a work in progress.
6. Finally, family comes first.
Family comes first and work comes second (or rather the practice and my patients come second. CQC, QOF, audit, appraisal and safeguarding are a very poor 3rd!
I am 46 with a fabulous husband and two glorious, healthy children. Why did it take me so long to work it out!
As before, if you have any thoughts or questions, or even a thank you to the author for sharing her poem, please do comment below. It takes a huge amount of courage to share something like this. (You will need to sign in here to do so if you don’t already have a WordPress account).