19 February 2018

Too busy for a break? Think again

General practice Mental Health

How are things? Busy? So goes a common greeting.  It suggests that all is well if all are busy.

It is also assumed that busy people are the most efficient – as in: “If you want something done, give it to someone who is busy.”

Philosophical traditions of how to live well rarely stray from the paradoxical.

Alex Soojung–Kim Pang writes about the perils and pleasures of being busy in his new book: Rest. Why You Get More Done When You Work Less (Penguin Life, 2017.)

A technology consultant in Silicon Valley, Pang noticed that when he was away on sabbatical his productivity flourished.  “I found that in three months I got an enormous amount of stuff done and did an awful lot of serious thinking,” he explained in a recent ABC interview.

In illustrating his notion of “deliberate rest” he points to Nobel laureate Barbara McClintock, the first American woman to receive an unshared Nobel prize. McClintock was a geneticist and Pang reports that when confronted with an unsolvable problem, she got up from her desk and went for a long walk.

More often than not the answer to the problem came to her while she was walking.

Paradoxically this was the woman who said: “I never thought of stopping, I just hated sleeping. I can’t imagine having a better life.”

Work and life can seem to be in competition when the conversation turns to “work-life balance”. Pang seeks to make them complementary.  He says, “deliberate rest” and “work” are partners: both essential in building a creative life.

Pang is not the first to contemplate the puzzles connecting work, a. Few ideas about the good life are new: most have historical antecedents running back to ancient Greece (in the Western tradition). As Socrates wrote, “Beware the barrenness of a busy life”.

The average GP’s working day is notoriously busy. However, with time, most GPs develop skills that keep them afloat in a sea of busyness.

As an example, my colleague Dr Simon Young1 writes, “I’m not a good Zen practitioner and don’t formally meditate, but I do practise mind-clearing after each patient. This is simply a moment’s pause to check in with myself and make sure I have cleared the past patient, their concerns and my response to them; and have the mental space to take on the next patient.”

Pragmatic and personal solutions to the pressure of incessant demand are often hard won. It is a lovely thing when they are generously shared.

My new year’s resolution is to give up being “grumbly old man” complaining about the lack of ambitious blue-sky initiatives for system reform which I still believe is necessary to ensure GPs are protected against the pressures of relentless demand. Rather, I resolve to seek out successful examples of reform or transformation already in progress.

The first instance of reform I want to tell you about is one that found me, rather than me finding it.

As 2018 dawned, I consulted with an infant I knew well. In the first six months of life the baby had a serious illness, now resolved and apparently without physical sequelae.

The infant’s parents were young refugees with no family in Australia and the father worked full-time.

This day the mother presented, upset saying her baby cried all day. What happens when you go out, I asked? “Then she is perfectly happy,” came the reply.

My diagnostic duty was done. The source of this disturbed parent-infant relationship clearly arose from impaired maternal wellbeing. While wondering what to do, I noticed in her notes a document declaring that this family was enrolled in GPS Kids Integrated Care. GPS Kids is auspiced within the Sydney Children’s Hospital Network. Most importantly, this document included details of three relevant contacts already involved with this family.

I rang all three but got no answer.

At this point I considered brainstorming ideas with the mother for getting out and about while making a mental note to engage supports later.

Had I made that decision, it is likely that the plan would have disappeared in my in-tray, never to emerge. As Dr Kirsten Meisinger2 says: “When the doctor has to do everything, the only certainty is that not everything that needs to be done will be done.”

Instead, I typed a quick email to the co-ordinator of GPS Kids and included my consult note and a request for her to engage the team.

In the days that followed each team member posted their findings and interventions on a group email. Collaboratively a really good care plan emerged. When the time came for an admission to Tresillian all this information went with mother and baby.

Speaking with the mother after her admission I found her happy, confident and delighted. Tresillian staff appreciated the insights revealed in the email thread.

The story is a work in progress. Electronic communication enabled a level of teamwork that would have been otherwise difficult, if not impossible.

The mother finds her relationship with each member of the team valuable. The value of this team is turning out to be greater than the value of each player operating as an individual.

The fourth of the Quaternary Aims is to maximise professional joy in the work.

Job done!

References:

1. Dr Simon Young Co-principal, The Practice, Blacktown, NSW

2. Dr Kirsten Meisinger, Medical Staff President, Cambridge Health Alliance, Massachusetts, US. Known as the Queen of Cambridge to her friends in admiration of her prominent contributions to health system reform