The year that was, (almost) all wrapped up

''General practice is great but it’s also bloody hard''. Do you feel as though you're stumbling toward the finishing line this year too? You're not alone... Dr Simon Cowap reflects upon the (often stressful) year that was, and offers some sound advice ahead of the New Year.  

I don’t know about you, but I always approach the Christmas break like an under-prepared jogger staggering towards the finish of a fun run. Started out in high spirits, went OK in the middle but by now it’s a lot less fun and seems to be going on forever. Never was a bit of time off so sorely needed!

General practice is a demanding business. It can also be very rewarding, but for most of us the demands and rewards are pretty finely balanced. So called ‘burnout’ is common in the health profession – over half of Australian GPs have considered leaving practice because of work stress. At its most serious we’re all aware of the tragic spate of medical suicides in recent years, particularly amongst junior hospital staff.

For me at least, there’s probably something about the end of year deadline that makes this time of year particularly taxing, but it’s worth taking stock of what makes our line of work particularly stressful. In general, we experience stress when we have more demands placed on us than we have the resources to deal with. Research into the stress of metropolitan general practice suggests the most frequent stressors GPs experience include time pressure, paperwork, phone interruptions, difficult to manage patients and earning enough money. The most severe sources of stress include threat of litigation, time pressure, earning enough money and difficult to manage patients. Unrealistic expectations also feature on both lists. In other words, we have too many interruptions, too many difficult patients, too much litigation and paperwork and not enough time or money. And no magic wand to resolve all the diabolically difficult situations our patients find themselves in.

These are mostly situational or external factors. But there are also things about us, personal attributes that made us want to do medicine in the first place and by and large help us be good doctors, that affect how we respond to these stressors. While many of us didn’t take kindly to the RACGP PLAN activity, most of us are nonetheless very self-reflective and our own sternest critics. Personality traits like empathy, having high standards, being driven, diligent, self-critical and responsible are common among doctors.  I want my own medic to have these qualities, but they do tend to make us more vulnerable to stress.

Stresses, both internal and external, abound in general practice. What factors have been shown to help us cope? On the resources side, it would be great if the Medicare rebate was at least double and we were appropriately remunerated for spending more time with our complex patients. But while Santa might bring me a revamped MBS schedule that rewards chronic care and time intensive mental health consultations, I doubt the health minister will. Another hour or two in the day would also be helpful, but that’s beyond even Santa.

When it comes to difficult patients, there’s no denying we do need to establish strong boundaries. Many of us probably do need to strengthen our internal border force. But while simple slogans are useful in politics, in reality it’s hard to be empathic and have good rapport while remaining completely immune to our patient’s emotions. Dealing with extremely distressed, anxious or demanding patients inevitably takes some sort of a toll. And sometimes it’s impossible not to resonate somewhat with the sheer sadness of some things we encounter.

Given that a degree of stress is inevitable, we do need to get familiar with how we personally respond and acknowledge when we are having a bad day. Not always easy though. More often than not it’s the kids or the partner who notice it first. ‘Dad why are you so cranky today?’ ‘CRANKY?? I’M NOT CRANKY… ‘

Personally, I find exercise the simplest and most effective way of dispelling the effects of a hard day in the surgery – though like my patients the days when I most need it are the hardest to get motivated. Shouldn’t I just stay on the couch and open a bottle of wine? As GPs we’re all familiar with stress management and I’m not going to try teaching you how to suck eggs. It’s not what to do, but making sure you do it that’s hard. As Mahatma Ghandi allegedly said ‘I meditate for an hour every day, except when the @#*% is really hitting the fan and there’s no time for absolutely anything and then I do it for two.’

But dealing with stress is not something we should do entirely on our own. Research suggests strong personal and professional relationships are the biggest factor in facilitating emotional resilience. Again, I’d say personally apart from exercise the ability to have a good informal debrief with colleagues is probably the thing I find most useful after a tough day. And it’s not just when you’re feeling stressed – improving your professional network and having a sense of camaraderie really helps insulate us from the negative effects of stress.

General practice is great but it’s also bloody hard. Congratulations on making it through the year and take the time to look after yourself and your colleagues this Christmas and in to 2019!


Simon Cowap

Dr Simon Cowap MBBS (Hons), FRACGP
Simon is something of an accidental GP who likes to pretend he’s an artist trapped in a professional’s body. He dropped out of his first degree (arts) and went to London to play bass guitar in a band too musically challenged even for punks. Dropping back in to university, he subsequently also failed to complete a science degree and a Masters of philosophy. His remarkable lack of artistic success has been continued by the non-publication of his several novels. Somewhere along the line he did finish a medical degree. He still harbours dreams of literary success but his family have forbidden him to give up the day job.