4 July 2018

No GP is an island …

General practice Mental Health

Three years ago, GPs at a clinic in suburban Melbourne attempted a daring experiment: they recruited a social worker to run a peer-support group once a month at lunchtime on a Friday.

This kind of group-based critical reflection is known to enhance professional practice and reduce burnout in other health disciplines, such as social work. 

But, as a literature review later confirmed, it had never been used by GPs in Australia. 

The literature around self-care for general practitioners is all about managing one’s own physical and emotional needs.

“The profession defaults to the emotional work of medicine being borne by the individual doctor, and his or her resources,” the authors wrote in a paper in the Australian Journal of Primary Health.

At first, the four GPs from Temple Hills Medical Centre were wary. They feared the shifting power and interpersonal dynamics might prove both unhelpful and uncomfortable. They questioned whether they really needed to be there. After all, they had many decades of experience as GPs under their belts.

But as time went on, the group developed its own culture of sharing, validation and trust. 

They reflected on ordinary clinical events, such as confidentiality, running late, personal relationships with patients, patient expectations of billing, elderly patients in residential care, coping styles, family violence and death and dying.

“These sessions have increased trust in participants’ professional capacities, provided a forum for problem solving and reduced ‘after hours’ and accumulated work-related stress or emotional fatigue,” the authors reported. 

“These were, we postulate, the result of a professional forum where participants could give voice to their experiences.”

Burnout, or emotional and physical exhaustion, is a major issue among medical professionals. A survey of 12,000 doctors by beyondblue in 2013 revealed that one in 10 doctors had suicidal thoughts in the previous year, while 3.4% of doctors experienced very high psychological distress compared with the wider community figure of 2.6%.

It might be challenging for GPs to find the time for extra work activities, but having the opportunity to reflect and get support from peers was invaluable, Associate Professor Grant Blashki, a GP specialising in mental health, said.

In general practice such peer support networks would need to grapple with the issues of confidentiality, privacy of patients, as well as setting a respectful and supportive culture, and finding an appropriate person to lead the group, he said.

For the GPs from Temple Hills, peer support became part of the monthly routine. 

Interestingly, not a single GP missed any of the sessions over the three years, despite Fridays generally being one of the clinic’s busier consulting days of the week.