If there was one thing that helped me deal with my own Primary Care burnout, it was hearing another General Practitioner (GP) stand up in front of a lecture theater of 200 people and say that they had been burned out too.
At that point, I had been feeling I must be the only person in the world feeling like this. Everyone else seemed so happy, even though we were all supposedly exhausted GPs. The data was clear: there was a burnout epidemic in Primary Care, too.
Burnout – especially in high-performing professions like medicine – often carries with it a burden of guilt and shame, which I I had within me in spades. Hearing someone else say publicly, that here they were, just back from time off sick, triggered the first part of my own process of healing.
Perhaps it was ok to be feeling this way, to be physically exhausted, wobbling back onto my feet and anxious. Perhaps I had not failed or let anyone down. Perhaps it was even understandable, given everything that had happened in the pandemic. Even though I come from a middle- class family, we had suffered badly, not directly from the virus but from the knock-on effects. I won’t say more to respect the privacy of everyone else, but trying to manage the mental health effects on different people during lock downs, elderly parents, frailty, cancer, and bereavements, almost tore us apart.
It was therefore with a very heavy heart that I resigned from my post in inner city general practice. Only a few months prior to that I had felt so heavily invested in my work: committed to work with the unseen and unheard people of society in one of the most deprived areas of London. Nevertheless, something within me was struggling to get out of the situation, and despite the guilt, I left.
Another lesson that life has taught me is to get help when things are difficult.
My barrier to asking for professional help is now very low and so I got in touch with someone straight away, someone who could see that I was in emergency and helped me see through to where I needed to go.
I was fortunate enough not to need to find work straight away. I spent a happy summer, doing a bit of urgent care locum work. Although urgent care felt ‘lesser’ in some respects than ‘proper’ Primary Care, it fulfilled a value of service to my own community, to work with a deprived population, and supported by a great team delivering high quality care.
With time away from the cause of my burnout, my family healed a lot of the hurts over and although the NHS remains in dire straits, the healing that took place within my family made me hopeful from a personal point of view.
So far, so good. But what happens now? Coming back to General Practice after a three month break, I still have to hold my hand up and say, I am still a little burned out in the Primary Care context.
I lack the desire to discover people’s stories, to form the relationships, or unpick what is really going on for them behind the presenting symptoms that often come as only a superficial offering. I had thought that by this time I would be up for looking for a new job and some kind of clinical leadership post, yet when exactly the right one came up, I stared at the advert, feeling that at this time, I had no skin left for that game. It left me with a momentary but deep sense of sadness.
What have been the gains from all of this? In spite of this sorry-sounding tale, the advantages far outweigh the losses. In moving away from daytime GP, it has been important to shift into something that still serves my values in other ways and that has made me realise that being an urgent care GP does not make me “less than.”
I now also understand and accept that I am human and I don’t have all the answers. I realize more, through working with a coach, what my strengths and values are and what keeps me going at work, one of which is connections. I am purposeful about creating more of these. And in doing these things, then maybe I can accept it is possible to hold both the sadness of losing some of my commitment and drive, and the happiness in finding other ways of working and living in a way that is still meaningful for me. Further, I am starting to think that perhaps it is possible to hold both.
In the midst of burnout, we hope so desperately that it will just go away, that we won’t or don’t need help, that there will be changes to our circumstances that take it all away or that one day we will wake up to find it turned itself off. This almost never happens. Systems prefer homeostasis.
But the opportunity here is to examine within ourselves why we are here, right now, in this moment? Why did we come into medicine? What is keeping us here? Who or what drives us and supports us and how can we create more of that?
While changing my work environment has helped hugely, I accept that I have not been fully cured of primary care burnout –yet. Perhaps there isn’t always a cure and knowing that in itself can be healing.
Nevertheless, I am happy today, and I am more of myself than I ever was. If we accept we are burned out and seek help, how would it be if this was actually an opportunity to grow into something else?
My message here for burned out colleagues is simple: seek help.