Are you depressed? GP Burnout

How are you doctor?

 I have twice suffered from depression in my medical career. It was horrible, a dark forbidding place I never want to go back to. I felt overwhelmed with fatigue and yet couldn’t sleep. I had profound ‘psychomotor retardation’ (Newton Faulkner has a song Uncomfortably Slow which articulates this feeling perfectly). My brain was so slow my wife could ask me a simple question and I was aware that I was just incapable of articulating a simple response. Just walking felt like wading through wet cement, getting up stairs a Herculean task. I had palpitations, chest pains, every muscle seemed to ache. Simple tasks and decisions became overwhelming. To try to cheer me up one day, she took me out (against my will) to our favourite coffee bar for breakfast. Looking at the pastries (which I knew would all taste of cardboard, as everything did) I just stared and stared and when the waitress gently pushed me to make a choice I was overwhelmed and broke down in tears. My wife had to lead me away, sobbing.

 It was all the more difficult because I was so very deeply ashamed of feeling like this. I had a good career, financial security, a happy marriage, 3 beautiful children – what did I have to complain about? One thing being a GP teaches us is how well people cope with terrible adversity, and yet here I was unable to cope with my ‘nice life’. I felt ashamed, and so hid it longer than I should.

 The first time I had it, I carried on working. I felt able to work even though things outside work were difficult. In retrospect I was on ‘auto-pilot’ a lot of the time and I’m sure I shouldn’t have been working, but one of the curious things about depression is that it changes the way that you think. You can no longer trust your own judgements. You think you can function, and because all your colleagues are stretched to the limit as well everyone colludes that you can. The second time, fortunately, coincided with a ‘between jobs’ period – I definitely couldn’t have worked then. I was helped with support from family, time and space to heal, CBT, exercise and mindfulness. I took sertraline for about 6 months which definitely helped get me re-booted (I really did feel something ‘chemical’ happen after a couple of weeks, just as patients often report), but it caused sufficient niggly side-effects that I didn’t want to take it any longer. However, I’d take it again if it ever came back. A much closer attention to work-life balance, regular exercise, mindfulness and a greater degree of psychological self-awareness, self-knowledge and emotional literacy has kept me well for over 5 years now and I am optimistic that I have beaten it now.

 The reason for this blog is that a recent spate of surveys shows that GPs are under more pressure and stress than ever, and increasing numbers are showing signs of ‘burnout’. I worry how many GPs may be working with depression and risking serious deteriorations in their mental health and addiction problems. A recent Dept of Health Survey shows that job satisfaction in GP is at its lowest, and stress levels at their highest, since 1998. The primary reasons for this are increasing workload and ‘lack of time to do the job justice’. We are working harder than ever, yet GPs are not afraid of hard work (the long working hours of a GP are in 7^th place in the ‘list of stressors’). A recent GPC survey shows similar results, and a Pulse survey revealed this year that almost half of GPs are at risk of burnout.

 Personally, I don’t like the term ‘burnout’. Let’s call it what it is, which is almost invariably depression.  All human beings, indeed all animals in experimental conditions, show the same response on the classic ‘stress-performance’ curve. A degree of stress is good – it motivates us and excites us and we see our performance and energy levels improve. But, eventually our performance starts to plateau and then as stress mounts our performance dips and we exhibit all the classic signs and symptoms of anxiety and depression. GPs show higher rates of mental health problems than other professions; this partly may reflect our personality, partly transference from the suffering of our patients (the ‘wounded healer’ idea) but mostly, I think, just the huge stress of dealing with large numbers of patients, managing uncertainty and shouldering huge responsibility.

 My advice, is that if you are struggling is NOT to trust your own judgement about your ability to cope and continue at work but to seek the help and opinion of others, be that from loved ones, trusted colleagues or other health professionals. And if you feel a colleague may be struggling, please don’t ignore it. Make the time to ask how they really are.

 Being a GP is a tremendous job and a wonderful privilege and I love it,  but it is hard and we are prone as professionals to depression and burnout. If this is you, experience has taught me that with time and treatment not only will you recover fully, but you will come back stronger than before. You will love life, including your job, again. And once recovered not only will you appreciate and enjoy life more, but it will also make you a better doctor. So, be brave and seek help and take some time out to get better. Because you will.

Simon

Resources if you are struggling:

BMA counselling and advice, just call 08459 200 169

BMA links for doctors in difficulty

Doctors & dentists group for addiction problems

Doctors Support Network

The sick doctors trust

Pulse Battling Burnout Campaign