In this week's "Pulse", a candidly honest GP talks openly about his experience of depression. He says "I have been on antidepressants three times in the past. Though they helped when I was taking them, I don't think there were the answer. The problem is the stress of being a doctor and how I cope with it". I think he is right.
During my recent appraisal my appraiser told me about how he got hopelessly bogged down and stressed by the demands of the patients in his previous practice. He changed practices, and now keeps strictly to time and limits the depth of engagement with his patients. Reading between the lines I think he is still stressed, but manages to cope. Moreover, his patients do not seem to suffer. To adapt the phrase of the paediatrician Winnecott, he is a "good enough doctor".
My own experience is that engagement with patients is draining. To be effective we have to engage at an emotional level to some extent. Every patient has not only a different set of circumstances but also a different view of life. To engage effectively with widely different people five times an hour for over three hours, with interruptions and only a snatched cup of tea, is hard work. We have to give of ourselves, and I take some comfort from the fact that Jesus Christ felt the same (Luke 8:40-48).
I think that I had been mildly depressed for several years, and that this got significantly worse and reached crisis point in the summer of last year. A course of an antidepressant helped, but so did a heart-to-heart talk with my wife who really hadn't understood why her husband was behaving so unreasonably. My home life had been severely affected because I was worn out and good for nothing when I got home. Often I would just fall asleep on the settee. I would pick up a little over the weekend, but then feel dreadful again by Sunday evening. Work was a nightmare, an unending slog. At the start of the day I didn't know how I was going to get through the morning surgery, never mind the rest of the day. It was an odd sort of depression, because it was completely work-related. During holidays I felt fine.
I have indeed been a fortunate man, helped by my understanding wife and family, by colleagues at the practice, and by an appraiser who had dealt with similar problems himself. Looking back, I think the main cause was a feeling of lack of control. Back in 2003 I had strongly opposed the New Contract, and played a small part in trying to oppose it. But the New Contract came into force anyway, and since then there has been an inexorable series of changes which have been hard to cope with. My locus of control was definitely external. My recovery has involved realising the truth of the saying that it is not things that are bad in themselves, but the view that we take of them. I am trying to reduce stress at work as much as possible, and to make the best of things. Like my appraiser I want to be a "good enough" doctor, with enough energy left over for me and my family.