Self-help principles alone not the answer for GP burnout: Expert says

Evelyn Lewin

20/02/2019 3:02:53 PM

The ‘impossible’ demands expected of GPs commonly leads to burnout, Dr Leanne Rowe warns.

GPs are starting to ‘switch off’ when they see articles about burnout, according to Dr Leanne Rowe.
GPs are starting to ‘switch off’ when they see articles about burnout, according to Dr Leanne Rowe.

In her 35 years of working as a GP, Dr Leanne Rowe, co-author of Every doctor: Healthier doctors = healthier patients, has seen just how prevalent burnout is among the profession.
While common, she warns, ‘it’s not normal’.
However, she worries the term itself is overused and that doctors in particular tend to ‘switch off’ when they hear it. The fact burnout is hard to define only adds to the medical profession’s general aversion of the term.
‘It’s about distress, it’s not a disease or a disorder,’ Dr Rowe told newsGP.
But she warns its effect on GPs can’t be overlooked. The first way burnout tends to manifest is through exhaustion, whereby doctors become ‘really drained and cynical’.
It also causes doctors to distance themselves from people outside their consulting rooms.
‘So doctors find work increasingly stressful and frustrating, and when they react by distancing themselves emotionally, they feel numb,’ Dr Rowe said.
Work performance also suffers, according to Dr Rowe.
‘[They become] very negative, they find it hard to concentrate, which is really tough when work expects them to handle constant interruptions and make hundreds of decisions a day,’ she said.
While people can experience burnout in any profession, Dr Rowe believes it is rife among GPs for many reasons. The mental overload experienced by GPs is a significant contributing factor.
‘GPs are meant to be across every sub-specialty in medicine and up to date with advances, which is an impossible task,’ Dr Rowe said.
According to Dr Rowe, dealing with grief, trauma and injustice – and how such issues ‘eat away at us’ – combined with the increasing burden of administrative tasks and isolation of working as a GP, provide a ripe breeding ground for burnout.
In addition, GPs often meet major challenges such as patient complaints and anger, litigation, discrimination, sexual harassment, bullying, and threats of violence, which cause extreme stress.
Rather than letting such an exhaustive list of worries overwhelm you, Dr Rowe believes it can help to hear that your feelings are justified.
‘I think it’s important to really acknowledge how difficult the job is, and to feel validated when feeling stressed. Acceptance of uncertainty and lack of control is sometimes the best antidote,’ she said.
If you’re feeling burnt out, Dr Rowe recommends looking beyond generic self-help strategies such as mindfulness, relaxation techniques, positive psychology. While she finds these suggestions valuable, and practices them herself, she finds that these measures alone sometimes don’t work that well for GPs.
‘I think that generic self-help and cognitive behavioural therapy [CBT] techniques don’t always work for doctors because we tend to overthink, and we can have negative cognitive biases,’ she said.
‘We’re trained to be risk-averse and always looking for the negative – this is part of providing safe patient care.
‘It’s very hard to switch off those traits, so expecting yourself to suddenly be able to challenge or change your thinking is not easy for anyone, but it’s not easy for doctors and can lead to further frustration. Awareness of the benefits but also the limitations of CBT may help.’
However, Dr Rowe is quick to point out that there are solutions and she advocates for better training to empower GPs to master these common ‘extracurricular’ issues.
While Dr Rowe doesn’t have a one-size-fits-all solution to burnout in GPs, she says taking time out for solitude and rejuvenation has made a significant difference to her own life.
‘Extreme stress sometimes requires extreme self-care,’ she said.
‘Taking time for yourself is not selfish, it’s really essential to rejuvenate so we can better care for others.’
She recommends taking enough time to actually replenish reserves with meticulous time management.
‘Instead of only recharging my batteries 10% and then letting [my reserves] run out quickly, I give myself permission to recharge my internal battery at least 90% capacity now so it doesn’t run out easily. That simple strategy has made such a difference to me,’ Dr Rowe said.
Then it’s about finding and planning activities that you find rejuvenating – regularly.
‘It’s what energises you and helps you switch off and find a deep sense of relaxation, and that’s different for everyone,’ Dr Rowe said.
While Dr Rowe laments the fact it’s taken her many years to implement such self-care in her own life, she hopes such strategies are taught as part of the curriculum for young doctors, to prevent and manage burnout. She believes talking to your own GP also helps.
‘Burnout can predispose doctors to depression so we ignore this at our peril,’ she said.
‘I personally feel so much more confident and happier in my work now that I’ve mastered these challenges and I feel we can share that experience, particularly with younger doctors, so they don’t have to learn through bitter experience.’

burnout self-care self-help

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A.Prof Christopher David Hogan   21/02/2019 1:08:55 PM

A very nice article, Dr Rowe.
I feel that Stress is often generated when our perception of what is occuring does not match our expectations of what should happen. One strategy is to change our expectations.
First - rather than "do not make a mistake" we should aim to "do a good job or do our best"
Second -so many recent fellows are concerned that they do not feel confident. Well, confidence in your abilities takes a while. So called Mastery of a discipline is said to take years, up to 10 years but I feel it is much less than that.

Adrian Ward   21/02/2019 10:01:41 PM

I agree with this article. A holistic approach must be taken. I like the acknowledgement of doctors being so close to social justice matters which we try so hard to soften for our patients. All this emotional and mental work means that we need to take time out. One of my strategies is to be involved in voluntary activities in a non-medical setting. And a lot can be said for a swim or brisk walk to refresh ourselves.

Sharmila Kumar   21/02/2019 10:33:33 PM

Thank you Leanne for sharing your experiences with everyone .
As a medical educator for GP Synergy, I know that from day 1 of the training programme, we are emphasising to GP registrars to find their own GP, look after themselves,.We even provide a mentorship programme .
As a suggestion to existing GPs , maybe we should include "self care" as a Category 1 requirement for CPD over the triennium. eg writing a report, or attending seminars or wellness weekends, .This way fellows are give themselves permission to consider , reflect and complete self care,
What do you think?
Dr Sharmila Kumar

roger williams   25/02/2019 11:49:55 AM

As a GP who is now only doing anaesthetics I completely agree that the task of delivering good quality family care is incredibly demanding; I am agog with admiration for those who manage it. My experience is that what I do now, complete until very recently with a 1 in 2 on-call roster is a lot easier. You people are unsung heroes who richly deserve our support.

Nazareena   25/02/2019 8:55:35 PM

Refuel refuel refuel ...... do something out of the sphere of medicine and keep yourself interesting and interested.
Housekeeping.... mental, physical and emotional- be self- aware and take steps to recharge before red light comes on.
If patients and practicing is becoming a chore.... you need a break.
And I guess on another level .... Lower your expectations of yourself and give yourself a break. Same advice I give to new mums...

Leanne Rowe   26/02/2019 11:14:30 AM

Thank you for the wonderful comments above, full of experience, wisdom and support.