Wednesday, 3 October 2007

A bad day

Things are not getting better as the week progresses. I am starting to feel that everything is an effort and that I won't be able to deal with problems. This is a bit like how I felt when things were bad last year, though not (yet) as severe. I had to supervise a medical student this morning on behalf of the partner who is on sick leave, but they hadn't given me any extra spaces in the session for the teaching. I find it stressful having an observer when I feel inadequate, and I ended up running nearly an hour late.

Several times during the day impending problems appeared to be insurmountable, although (of course) once I started to deal with them I was able to sort them out quite well, and in a reasonable amount of time. Once of twice during the day I felt that I could not carry on doing this job. But I realised that my cognitions were false and did my best to treat myself with some CBT.

I have had some helpful support at work. The staff have been understanding. I had a little chat with our senior nurse, who is my age and has been at the practice almost as long as I have. “Don't worry” she said as she gave me my flu jab, “it's only nine years until we retire. It won't be long.” And she said that she thinks I am a good doctor and that the patients are lucky to have me. You can see why I like her. Then this evening Martha sent me a charming email: “I just wanted to say that you may well feel that you are not coping very well for one or more reasons. But finishing a heavy surgery with a new medical student an hour late is not evidence of acopia, it is quite normal. You place quite a heavy burden on yourself when you try to be a good doctor in the short time available. And you achieve it a lot of the time. The Impossible takes a little longer, as it says in the laundrette!” I like Martha, too.

The stressors are clear. Because of sick leave and another partner on holiday, my work load is considerably higher, paperwork is building up, and the study mornings which usually provide respite have had to be cancelled. It is far from clear when the ill partner will be able to return and, as Martha helpfully pointed out, responsibility for sorting things out has fallen on me - as it usually does. I can cope with being a full-time GP, but I can't cope with being more than a full-time GP.

My course of action is also clear. I must continue to think relentlessly positive thoughts, monitor my mental state, and “debrief” regularly with Martha. That, at least, is no chore!


Elaine said...

Well, Dr Brown, Life has been somewhat chucking it at you recently, has it not? It must be rather hard to let go of striving to be perfect and instead settling for "good enough"

Take care. :-)

Anonymous said...

I'm a medical student doing my GP placement just now. I'm at a rural practice with one GP working at a time (usually). I often feel bad because I feel I'm making the surgery run late, even though I know when I look at the waiting times I'm not really.

I guess it's because I'll often spend much longer with one patient than the GP can, so by the time I'm reporting back he's seen about three people! Recently it was very satisfying for both myself and the GP when I spend that bit longer with the patient a whole psychiatric history we didn't know about comes out. Hopefully now we'll be able to help someone who has been a "heartsink" patient for the past three months because I've maybe got closer to the bottom of what the actual problem is. My reward... I have to write my first ever proper referral letter!

Anyway, I love the blog. It gives me plenty to think about. Hopefully things will calm down a bit for you soon, so hang on in there.

Dr Andrew Brown said...

Elaine: I've never tried to be perfect, "good enough" is hard enough to achieve even 80% of the time. But your kindness is appreciated. Thanks.

Anonymous: It's really up to the practice to timetable things so that patients are not kept waiting too long. And patients don't usually mind waiting a little if they know they will be well looked after.
It sounds as though you are starting to be bitten by the GP bug - watch out!
I'm glad you like the blog. I was in two minds about whether to post about my stress and distress, but I think that the blog should reflect me, warts and all. I just toned it down a bit!