Keith:

Dr Keith Karing had just about got through his appraisal without mentioning his main concern; he didn’t want to burden his Appraiser with his personal stuff when everything was going so well with the practice. And after all, he would be taking early retirement in a few years and then would be able to recharge his batteries after 28 years of the NHS.

But his Appraiser, another GP he had known and liked for an equally long time, was one jump ahead. “You don’t seem to have quite the old sparkle these days,” he had skillfully commented. Keith had not been able to stop himself;

“You’re right, and I’ve got to tell someone, but please it’s just between ourselves.”

“Of course, Keith.” His Appraiser meaningfully closed his laptop and put down his pen. “It will go no further.”

“I really have lost not just the sparkle but the interest. I wake up in the mornings and think, is it really worth going in? And when I get to work I’m just going through the motions. I still like the patients, but helping with their interminable, endless, petty problems just seems pointless.”

“You used to be so full-on with it all,” his Appraiser commented.

“I know, that’s what makes it all so strange. I suppose it started a couple of years ago, but I just can’t be bothered any more. And yet as you’ve seen from all the appraisal stuff, I’m functioning perfectly well, I get on well with my colleagues and pretty sure I’m sure I’m not depressed. But I don’t even enjoy my time off these days either, and I certainly find any positive effect from a holiday wears off within hours! Then there’s all this new stuff we’re supposed to do. I like good old-fashioned medicine, and I think I’m quite good at it – no complaints and all that – but all these new guidelines and targets I just can’t be doing with. Do you think I’m getting burnt out?”

“Well, I was wondering when the B-O word would crop up!” His Appraiser looked sympathetic. “You do seem to have some of the features, don’t you. Have you thought about what you could do?”

“Really, I’m just hanging on til early retirement.”

Jenny:

Jenny closed her front door behind her and realised that she had reached a crisis in her professional life.

As a GP with 20 years experience in the same practice, she had seen many changes.

She had always enjoyed doing the best for her patients, and had tended to keep a low profile in the business side of the job having opted at the outset to be salaried rather than a partner.

Lately she had begun to find that many of her patients, now older people with more frequent visits, seemed to really value her personal approach to them. She often received small gifts and letters of thanks. But this situation, which she would normally have found both heart-warming and motivating, was starting to cause her irritation and a feeling that she was being manipulated.

Increasingly over the last few months she had been feeling drained and lack-lustre when it came to work, work that she would normally have found stimulating and which she would have looked forward to. She found herself rushing through the work just to get it over and done. Last week she had actually missed a morning’s work and phoned in to say she had D and V. But the real reason was that she just could not get out of bed with the prospect of her morning seeming so pointless.

But probably the biggest issue was the change in the way the practice was run now. Since the latest round of NHS changes, everything was being minutely managed so that she as a non-partner, had to meet a quota of clinical work which left little time for any interaction with the patients – the only part of it she really enjoyed, she now realised.

The crisis had come when her senior partner and the manager had taken her aside in the coffee room and suggested pretty clearly that she was underperforming and needed to do better, and very soon at that.

She felt bullied and undermined, as if the whole of her career had been swept away by their words. Holding back her tears until she was out of their sight, she had managed to get herself home feeling empty and desperate.

Her GP hadn’t been particularly helpful (maybe she herself was at the end of her tether), but had been very clear that Jenny did not have significant depression. Being invited to a follow up at the surgery after 6 weeks had been surprisingly comforting though.

The worst part of it was that she now felt that everyone at the practice was ganging up on her, and she really could not talk to anyone.