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 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.
Start by writing down a list of the sources of stress that you identified with the Work and Home Overview Tables. To this list, add the most frequent and serious sources of stress you identified with your Stress Diary.
Review this consolidated list and redraft it in order. The items at the top of the list should be the most important for you to resolve, while the ones at the bottom of the list can wait until you have the time to deal with them.
A stress diary is a record of when you felt stressed, the event which gave rise to the stress, how you felt stressed, and how you managed it.
Recording short-term stress can give you useful insights into both causes of stress and your pattern of reactions to them. Often our consciousness of stress is fleeting as other more urgent things take over. A stress diary separates out routine stressors from more unusual ones, sharpens the focus and makes a clear analysis of stress factors, and responses to them, possible.
When?
Once an hour or after any incident which is stressful enough for you to feel it is worth noting. Make it a routine part of your note taking.
What to record?
Use the template which you can download below
Date & Time Event: What happened?
Level: Level of stress caused by event 0 = least stress 10 = most stress
Feeling: How did the stress manifest – eg. hands sweating, upset stomach, panic, headache, faster heart rate, anger.
Underlying cause: Is it just this incident in itself that is stressful or is there something about it which has triggered the stress? Is it cumulative for example? Is it reminding you of something else? Try and be as clear as possible about the basic cause.
How managed: How well did you handle the stress? Did you ease the stress or did you make it worse?
If you recognize the warning signs of impending burnout, it’s likely to get worse if you do nothing. But by taking steps to get your life back into balance, you can prevent burnout from becoming a full-blown breakdown. The steps to prevention are as follows:
Burnout Resources
Burnout is a gradual process that occurs over an extended period of time. It doesn’t happen overnight, but it can creep up on you if you’re not paying attention to the warning signals. The signs and symptoms of burnout are subtle at first, but they get worse as time goes on.
Contributing factors include work,lifestyle and certain personality traits. What you do outside working hours and how you look at the world can play as big a part as more obvious causes.
You may be on the road to burnout if:
The Mind Tools website contains a very useful, online, informal self-test for Burnout.
Stress and burnout, though often used interchangeably, represent distinct states of mental and emotional strain, with stress characterized by heightened engagement and urgency, while burnout manifests as a pervasive sense of detachment and despair.
| Stress | Burnout |
| Characterised by over-engagement | Characterised by disengagement |
| Produces urgency and hyperactivity | Produces helplessness and hopelessness |
| Loss of energy | Loss of motivation, ideals and hope |
| Leads to anxiety disorders | Leads to detachment and depression |
| Primary damage is physical | Primary damage is emotional |
| May shorten life | May make life seem not worth living |
Adapted from D. Hart and quoted in ‘Stress in Ministry’ by R Croucher
Burnout is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed and unable to meet constant demands. As the stress continues, you begin to lose the interest or motivation that led you to take on a certain role in the first place.
Burnout reduces your productivity and saps your energy, leaving you feeling increasingly helpless, hopeless, cynical, and resentful. Eventually, you may feel like you have nothing more to give.
Self Help Gym
Staff Room
Consulting Rooms
Managers Office
Stress Reduction Centre
Burnout Recovery Suite