I hope you will excuse a little more self-assessment (or self-indulgent navel-gazing, depending on your point of view) before I get back to those exciting tales of derring-do in the consulting room. But this is rather important to me.
For some time I have been depressed at work, although lately it has only been at work. I enjoy my time off very much indeed, my family are wonderful and I have good friends. But work has stretched out like a tedious gruelling ordeal every week. I now think that the basic problem has been my lack of confidence in myself. I was fairly confident in my early days as most young men are. But as I got older I was no longer young enough to know everything, as Oscar Wilde remarked. I think that my confidence was also slowly sapped by the ever-increasing demands of the criteria to remain a trainer, and then by the onset of appraisal and revalidation. And I have misread the signs. All doctors make slips and errors from time to time, but each one I made was evidence that I wasn't good enough for the job. And there are bound to be occasional grumbles by patients, but each one fortified my belief that I was doing badly. We don't get a lot of overt praise and I assumed that the praise or thanks I did receive was just politeness or, alternatively, badly informed. They thought I was a good doctor but really I was just successful at pretending to be one. I was embarrassed to receive the occasional present. My 360 degree assessments were positive except for the fact that practice staff found me grumpy and difficult to approach, which was a side effect of my lack of confidence. Sometimes there were signs that were difficult to misinterpret. Martha, whom I admire greatly, has always thought well of me and seems to see me as a clear thinker who can cut through obfuscation in diagnosis or management with my sharp wit. Yet even there I felt that she was somehow mistaken.
Looking back I am far better than at my nadir about three to four years ago when my depression spilled over into my personal life and things almost ground to a halt. I was never suicidal but at one point I remember thinking that I didn't really mind whether I lived or died. I can understand why doctors sometimes kill themselves and I am extremely grateful that I never got that bad. Fortunately I am good at calling for help, and I have received an awful lot of help and support from Martha and another very good friend who fortuitously has a lot of experience of helping doctors in difficulty. I am indeed a fortunate man.
Since then things have slowly picked up, but it is only recently that I have started noticing all the positive feedback and begun to believe it. Over the past few days I have spotted several occasions on which anxious patients were reassured, as much by my personality as by my explanations. I usually have young children eating out of my hand. And this evening I was talking with my daughter over dinner when she informed me that I have a secret admirer. She currently has a summer job as a sales assistant in a shop in town and today she found out that her supervisor's mother is one of my patients. I know the mother quite well, she is in her eighties and I try to look after her properly because she is the widow of a local GP who died many years ago. The feedback I got today, daughter to daughter, was “he's so dreamy, he's such a good doctor and gives you plenty of time”.
So there you have it. Fortunate and dreamy, that's me. :-)
I really am feeling quite a lot better, and I might even continue working as a GP for a few more years. With a bit of luck this blog might become more upbeat as well.