GPTQ Assistant Medical Educator Dr Kathie James has been a General Practitioner for almost three decades. She knows the important role mental health plays in being able to manage the stresses and challenges of the job. In support of Mental Health Month this October, Kathie shares with us some of the insights on managing mental well-being she has gained over the years.
My friend’s daughter is a circus acrobat. Last year I saw her perform a phenomenal show with her crew (We Live Here, by Flipside Circus at QPAC), which explores the emotional burdens and experiences of families (parents, children and siblings) and staff at Hummingbird House, a respite centre for children with life-limiting conditions. The image above is from the show, taken just a few seconds before the artists on the outside lifted their feet off the ground so the central performer could take on the weight of five people by herself. Some days in general practice feel like this, so I thought a circus analogy might be helpful!
1. Establish and maintain your strength. No one attempts a difficult act without ensuring the daily background strength work is done. Ensuring a routine around what you need is vital. Your strength workout may involve eating well, exercising, something mindful (prayer, meditation, gardening, music, other creative pursuits), spending time with loved ones, and getting out into nature for some vitamin D and endorphins.
2. Practice your routine. Try to get to work early; if you start late, you will only get later. Try to make time to review your notes each day. Keep a ‘to do’ list and work through it before your leave work; e.g. results, emails, things to follow-up.
3. Know your weaknesses and prepare. There will always be something you find harder or more stressful. General practice is so broad that it is hard to avoid entire areas of clinical practice, definitely in training and early years, and ideally long-term if you are going to be able to offer your patients good care. It helps to identify your areas of uncertainty or discomfort and work out why. Is it a lack of knowledge, experience or a personality trait? We encourage our children to go with their passions with extracurricular activities, but we also try not to let them have to cope with large deficits in critical areas such as maths and literacy. Parents get tutors in and build confidence rather than encouraging avoidance. As self-directed learners, we can seek to build our own confidence by improving our knowledge base, practising, and seeking support. Learning plans can help you identify both what you love, and what needs work. I probably will never find it easy to manage people with either chest pain or acute suicidal thoughts in general practice, but I can improve my skills to deal with these presentations better and feel less stressed. Seek out good courses and additional training, and talk to your supervisors and educators.
4. Know your limits. If you are constantly out of your comfort zone, it will be stressful. Use resources such as your Supervisors, phone a friend (or specialist expert), refer if in doubt, follow the steps to let you sleep at night rather than worrying about a risky decision.
5. Watch out for frayed ropes. If you are starting to feel tired and stressed, unwell or burnt out, act on the warning signs before you snap. Be aware of not only your obligations to the practice, but theirs to you. You are entitled to holiday, sick and carer or emergency leave. If you need to, take it.
6. Try hanging upside down for a different perspective. Sometimes we just need to take a different viewpoint. This may be helpful to deal with a patient we find frustrating, by trying to see things from their perspective. It can help stop us from making molehills into mountains and get our worries down to size.
7. Don’t overload your trapeze. You can’t always control the additional weights you may be asked to take on (e.g. COVID-19), but some are under your control. Consider if it is a good time to have an additional role or try to move or renovate. Worrying can be a huge weight to carry all the time; some options to put this weight down might include setting aside worry time, writing down your worries to work through, or using the Reach Out Worry Time App.
8. If you do feel yourself slipping, take time to get a better grip to regain control. If there has been an emergency and you are running late, it might be better to see if some patients can be rebooked rather than trying to function under the stress of being behind and risking providing substandard care because you are stressed and in a hurry.
9. Have a safety net! Like death and taxes, tough times when you lose your grip and need the net are inevitable. Having a strategy in place for your safety net before you drop can be helpful. Plan ahead. What and who is your safety net? Your partner or Supervisor often are key components, but what if they are the problem, or can’t be the ones to talk to? It’s good to have a range of options: your own trusted GP, reliable friends and/or family, peer support and some experienced colleagues, the phone number of your medical defence and doctor health advisory service, employee assistance programme and training advisors. Support is available from your Registrar Liaison Officer as well as GPRA. We may hate role plays, but like mock clinical scenarios, preparation is key. Who could you talk to if you had an adverse event at work or a complaint? What about if you found yourself attracted to a patient? Or if you stopped enjoying work and life? Having the net in place and bouncing back up is a better outcome.
10. Grab a helping hand! There is an extensive list of resources on the GPTQ website under the heading ‘Help and Support’. Log in to access.
Thanks to Ayesha Ghouse Ahmed and Ricky James for some of the Registrar perspective tips included.