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‘I can’t do this anymore’: How burnout affects doctors and patients


Evelyn Lewin


5/03/2021 4:26:13 PM

Two GPs open up about their debilitating experiences with burnout and the steps they took to overcome it.

Dr Tim Jones and Dr Hester Wilson
GPs Dr Tim Jones and Dr Hester Wilson have both experienced burnout and know it can not only have a debilitating effect personally, but also on patients.

Around 10 years ago, Dr Hester Wilson almost walked away from general practice.
 
The GP and Chair of RACGP Specific Interests Addiction Medicine was having a particularly gruelling day.
 
She had been seeing a lot of patients with ‘really complex’ mental and physical health issues around that time.
 
Dr Wilson was also tired, as she had been up overnight with her sick pre-schooler.
 
That day, a patient presented after being recently hospitalised for alcohol dependency and a number of other health issues.
 
This patient had no discharge letter, no plan in place, and had just started taking a whole host of new ‘off-label’ medications prescribed by a specialist.
 
To make matters more complicated, the patient was floridly psychotic.
 
A number of factors meant mental health services refused to step in, leaving Dr Wilson feeling both ‘angry and frustrated’ about her inability to properly care for this patient.
 
She had to reschedule or transfer her other patients to other doctors in the practice while she spent almost three full hours trying to manage this patient.
 
‘In the end I sorted something out,’ she told newsGP. ‘But it was at that point that I went, “I just can’t do this job anymore. I just cannot do this. This is too hard”.’
 
Dr Wilson knows she is far from the only clinician to have felt this way, and cites a 2019 Canadian study that examined the experience of GPs managing patients using opioids to manage severe pain due to osteoarthritis.
 
It reported that GPs struggled with frustration, exhaustion and compromised job satisfaction, which the researchers suggested were symptoms consistent with burnout.
 
‘What they found is that GPs feel overwhelmed by the complexity of trying to manage their patients and their inability to actually assist this group of patients,’ she said.
 
‘And burnout is one of the things that happens as a result of that.
 
‘It makes absolute sense that it gets to the point where as a human being you go, “I just can’t give anymore here. I can’t manage this anymore. The negative emotions are too distressing. I’ve got to opt out”.’
 
Dr Wilson’s belief that burnout is a real risk for all clinicians, and can lead to lack of empathy towards patients, are mirrored by the findings of a new study published in The New Zealand Medical Journal.
 
The research surveyed almost 200 senior medical officers from a variety of specialties and found that 45% of them were experiencing high levels of personal burnout. 
 
Of the 178 subjects surveyed, nine of the 10 doctors who had patient-related burnout also had personal and work-related burnout.
 
The authors then found a statistically significant negative correlation between empathy and patient-related burnout, which they said suggests that empathy reduces as patient-related burnout increases.
 
‘Burnout – a syndrome that is characterised by emotional exhaustion, depersonalisation and low sense of personal accomplishment – has been associated with a higher frequency of medical errors, lapses in professionalism, impeded learning, problematic alcohol use and suicidal ideation,’ the authors wrote.
 
‘Burnout is important because it can damage doctors and impair patient care.’
 
While the survey involved hospital-based doctors in New Zealand, Dr Wilson believes the results would be similar in Australian GPs and says there are a number of contributing factors.
 
Firstly, GPs are under the stress of balancing financial needs with patient care.
 
‘We have the dynamic of being a small business trying to make ends meet, money-wise,’ she said.
 
‘If you don’t see people, then you don’t make money.’
 
There is also a need to balance the desire to earn a good living while not overcharging patients.
 
Dr Wilson says she is aware of how many patients live in poverty, and the detrimental health effects of this situation.
 
‘But our fee-for-service model does not support good medicine for people who live in poverty,’ she said.
 
Isolation is another important contributor.
 
‘We work in isolation,’ she said.
 
‘You can be part of a busy practice and assisting people, talking to people, organising things, all that kind of stuff, but not actually have that kind of human contact which is about you as a human being interacting with your colleagues.
 
‘Particularly if you’re working with patients who have really complex issues it can feel really lonely, that you’re on your own trying to manage impossible situations that you can’t solve.’
 
Trying to manage patients in those ‘impossible situations’ is emotionally draining.
 
‘How do you manage your own emotional distress around [knowing you] can’t fix [a patient’s problems]?’ she said.
 
‘You can switch it around and go, “It’s all this person’s fault, they’ve done it to themselves”.
 
‘Or you can go, “I don’t want to notice it, I don’t want to feel it, I don’t want to have this negative emotional feeling so I’ll just pretend it’s not there”.
 
‘So that’s lack of empathy, that’s where it comes from.’
 
Dr Tim Jones also understands the flow-on effects of burnout.
 
The Tasmanian GP experienced this issue firsthand while working as a paediatric registrar.
 
He struggled with the fact the culture in the hospital he was working at ‘was not patient-focused’, and grew frustrated that he was unable to change the system single-handedly.
 
Dr Jones was left ‘quite emotionally burnt out’ by the whole experience and says it helped inform his decision to enter general practice.
 
‘That was one of the reasons for choosing general practice as a specialty; to make sure that I was looking after my patients and myself in equal measure,’ he said.

Burnout-and-empathy-article.jpgThe COVID-19 pandemic has only added to the feelings of burnout some doctors experience.
 
While Dr Jones says he has not experienced burnout as a GP, he can understand why it is prevalent and echoed Dr Wilson’s concerns regarding the effects of isolation.
 
‘General practice has many strengths as a profession, but we can be a little bit isolated,’ he said.
 
‘We can sit in a room and see patients and not necessarily have contact with too many other people in a day.
 
‘If we [also] soak up a lot of our patients’ problems in a day we’re at risk of burnout.’
 
He believes burnout is more of an issue in general practice since the pandemic and says the fact that mental health services are being ‘overwhelmed’ at the moment is further compounding these issues.
 
‘A lot of patients are struggling with burnout too,’ he said.
 
‘They’ve been dealing with different circumstances for a long period of time.
 
‘As GPs we’ve soaked up more of the load with our patients, so as a result I think everyone’s feeling the pressure more than we did before COVID,’ he said.
 
Dr Jones finds that these pressures can also contribute to waning empathy in clinicians.
 
‘I believe in a concept called “compassion fatigue”,’ he said. ‘Which means that even if we can still provide care in terms of what a patient needs, it’s hard for us to get on the same emotional level that our patients are on, [a level] that really helps them to feel like we can empathise with their problems.’
 
Nowadays, Dr Jones tries to avoid losing empathy with patients by being actively aware of how he is feeling about them.
 
‘If I notice that my level of compassion for a patient is starting to slip, or my apprehension about coming in contact with a patient I know is going through a really rough time is starting to rise, I know that I have to be proactive about taking a bit more time to essentially put my own oxygen mask on and look after my own emotional needs before I can get back into helping my patients,’ he said.
 
For him, that means spending quality time with his family.
 
‘Everyone finds their own path,’ he said.
 
‘But for me it’s been practically taking an extra-long weekend here or there, or finishing a session a bit early so I could spend a bit of extra time with my kids.
 
‘It’s trying to take a proactive approach before things get more significant and there’s resentment around patients or work creeping in.’
 
Since Dr Wilson’s brush with burnout, she’s also put a number of systems in place to help her avoid feeling that way again.
 
Dr Wilson credits GP support groups with her colleagues for helping her feel less isolated and better supported.
 
She also makes sure she exercises, eats well, stops for lunch, has breaks, and does not spend ‘too many hours’ at work.
 
And despite all the challenges associated with the COVID-19 pandemic, Dr Wilson does not feel at risk of burnout, primarily due to the changes she made following her past experience.
 
‘It was a real wake-up call for me that I needed to do things differently,’ she said.
 
‘I love my work and I love my life; it’s making sure that you get the balance right in your life.’
 
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Dr SHA   6/03/2021 7:18:20 AM

Being an IMG GP makes us even more vulnerable.Usually working in rural areas, more isolated and much less supported. Tangled in the web of a system which at best feels daunting and at worst feels totally unsympathetic to the IMGs.


Dr Bethel Skilbeck   6/03/2021 8:06:26 AM

I live and work in Central Queensland is there a support group locally. I have hit rock bottom. I am having a break in 10 days time to have no clinics. I have tried having breaks in the day and going 3 days a week. The demand of patients is such I work through lunch breaks and do 12 hour shifts. There is no joy left. Locally I can’t connect with colleagues as they are in the same position too busy.


Dr Edwin Kruys   6/03/2021 8:28:12 AM

Thank you Hester and Tim for sharing your stories and experiences. Healthcare can be a stressful environment and it is indeed important for all of us to have strategies in place to protect our wellbeing.


Dr Hester Hannah Katherine Wilson   6/03/2021 9:08:11 AM

Hi Dr Sha, I am sorry to read your experience. It can be harder to access support as rural a GP and even harder if you’re isolated from your culture and community. Virtual communities can help and I encourage you to look at what the college has available, there special interest groups, Facebook groups etc. NSW. Faculty is supporting a Drs wellbeing weekend. Your message has prompted me to ask the college how they can help.


Dr Nell De Graaf   6/03/2021 10:22:16 AM

Hi Dr Bethel
Please look after yourself and stop work for a while and /or work PT no matter what the demand is.
Women GPs often have more difficult needy patients which is draining and often have young kids as well who need your time.
You cant /wont help others when you have nothing left to give...🥰


Dr Karen Linda Price   6/03/2021 10:42:51 AM

Dear Dr Sha and Skilbeck,
Please contact me at racgp@racgp.org.au
Direct it to myself and Dr Michael Clements who is chair of the RACGP rural faculty.

We would like to understand better how we might help you both.
Warm Regards
Karen Price.


Dr Duncan MacWalter   6/03/2021 11:49:56 AM

Moral injury, not burnout. The blame lies on the system, not the individual. https://youtu.be/L_1PNZdHq6Q
(I don't always agree with his opinion, but this is a good one)


Rural GP   6/03/2021 12:27:55 PM

Thanks for this article and youre honesty. Yep, I put my hand up.
It is very confronting to find you can come across as grumpy rather than empathic. That you dread patients expecting too much or that too complex for level B.
Even simple decisions before are now hard because you doubt yourself. Even harder when you own the practice and everyone else feels the same . Who fills the gaps ? if everyone is making sure their OK, somebody still has to see the extra patients and do after hours.
You can see I dont know the answer? We cant play the victim card, we need to change the situation for ourselves. How ?


Dr Karen Spielman   6/03/2021 12:55:27 PM

Thanks Hester and Tim for sharing your stories. The pandemic has really stressed the system and showed us where the weaknesses lie and I agree that the management of complex patients who fall between the cracks has become even more difficult. It upsets me that we have to waste our precious energies on battling the system and trying to get care for these needy vulnerable patients and then on top of that worry about being audited for long consultations and whether to put the 2713 before the 36 or vice versa (or whatever)!! At least a positive has been the profession recognising the importance of self care and looking after each other - now with good leadership (Thank you Karen Price) I hope we can continue to advocate for systemic change to better value whole person specialist generalist medicine and ourselves as central to that.


Dr Karen Spielman   6/03/2021 4:03:24 PM

Thanks Hester and Tim for sharing your stories. The pandemic has really stressed the system and showed us where the weaknesses lie and I agree that the management of complex patients who fall between the cracks has become even more difficult. It upsets me that we have to waste our precious energies on battling the system and trying to get care for these needy vulnerable patients and then on top of that worry about being audited for long consultations and whether to put the 2713 before the 36 or vice versa (or whatever)!! At least a positive has been the profession recognising the importance of self care and looking after each other - now with good leadership (Thank you Karen Price) I hope we can continue to advocate for systemic change to better value whole person specialist generalist medicine and ourselves as central to that.


Dr Mandana Arshi   7/03/2021 10:22:17 AM

Its a true aspect of our lives as a GP, totally feel the situation! I should add then there is our family, young children, Studying for our RACGP exam, i am not aware of any support from our RACGP college, regarding mental health, it recommend ‘if you feel stressed seek help’. Just studying for our college exams, failing the exam, would be enough for burn out! I am preparing/ sitting for exams 2 years + last year of COVID-19 exam postponed,.. felling tired and lost !when asking college about feed back of our exam, no answer! Only numbers. Its really heart breaking😰


Dr Gursel Alpay   7/03/2021 1:29:11 PM

This is a timely article to demonstrate morale of the primary practice. Increasing work load, unable to find enough doctors (flow has been effected due to pandemic and our federal governments counterproductive policies of work force in general practice). Increased corporatization and fee for service are not helping and compounding the problem. After hour service by GP's has been killed by our Federal Government and now we will see more loaded ED's. On top of the above, new red tape legistaliations, Centrelink Medical Certificates Online (need several corrections before accepted), writing authority prescriptions ( excluding streamline), EPC and Mental health care plans are few to mention for increased bureaucracy . I have been working for the last 38 years and I have been experiencing personal burnout over the last 10 years.


Dr Timothy Paul Shannon   8/03/2021 10:23:29 PM

Reading these comments puts my problems in to perspective. I have a primary care addition practice with 200 on ORT. I used to feel confident in managing them but after leaving a corporate practice that changed. Patients were not informed about my new address and there was an investigation by the company into my practice. They were not aware of my opiate prescriber status. They coped 1500 pages of my notes to ahpra and had gone through my private Gmail account. (Forgot to sign out) and of course they found concerns as I have patients with complex physical and psychiatric disorders It was felt I was practicing inappropriately. 4 zoom meetings and 6 months later the investigation continues.
I am angry that my reputation has already been damaged and hell from Aphra which will not change what I am doing. Trying to do the most for my patients but with less courage and more anxiety. Fortunately I have a supportive family and exercise frequently.


Dr George Burkitt   13/03/2021 9:57:03 AM

A key factor is the destruction of the doctor-patient alliance with patients being seen as "consumers". We must radically refusal to accept and collude with this model. It means that the patient i.e. "customer" is always "right". Doctors are increasingly fearful of their patients and regulators who make it too easy to complain - the more complaints, the bigger their empires grow. There is no proper due process for the subjects of complaints to test the evidence of complainants. Let us apply Christian Porter's arguments for staying in his job to the processes of AHPRA and the state complaints bodies. The retrospectoscope will always reveal a way to blame the doctor. Systemic issues so often set up mishaps - poor pay for long consults a major issue. The number of contributors to feedback such as this and other portals who respond anonymously is a measure of how unsafe so many of us feel. I do it myself. I have lost trust in the the profession as a whole to have my back.


Dr M Isaac   15/03/2021 10:47:38 PM

Great to see Dr Karen Price ( RACGP President ) is commenting on this issue and giving a bit of support to vulnerable GPs. It is about time to consider if IMG should be left in the bush with no much support while coming from different backgrounds and they dont know the system well, is it right to bring doctors from overseas and leave them in isolated area, they dont know the system or they might not have enough skills to work in isolated area? is this safe? if you are really worried about safety (wink wink). The other issue as mentioned by Dr Burkitt is doctor/ patient relationship, is it a consumer relationship? I usually tell the patients" we are not in a lolly shop here to give you what you want" there are risks and side effects of medications, guidelines that we have to follow , so it is not what the consumer wants .. this is a medical field and if we open the door to consumer rights then I dont think we need doctors anymore! RACGP needs to step up and show leadership .


Dr Jitendra Natverlal Parikh   31/03/2021 10:53:48 PM

what is this BURN OUT
I am 1966 IMG with higher O&G qualification
I use but struggle with computer but managing and get help when needed
I actively involve with all GP organizations to shield me from hopelessness and helplessness
I although solo keep actively involved with anyone who cares
I do feel regularly that people avoid me but I do not
I thoroughly enjoy what I do and have no intention to retire or cut down my work although I am less busier than before
Lastly I am a carer for 2 family members and get occasionally overwhelmed
so what is burn out ?