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‘I can’t do this anymore’: How burnout affects doctors and patients
Two GPs open up about their debilitating experiences with burnout and the steps they took to overcome it.
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.
The 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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