Emotional labour is a pivotal factor in general practice stress and burnout, a study of English GPs has revealed.
By undertaking in-depth interviews of 47 primary care doctors, researchers found that one of the biggest causes of chronic stress and distress was the pressure of managing patients’ psychological and social problems, as well as the abuse and confrontation often directed at them.
One GP described the emotional work as though patients were “hanging tiny weights on you”.
“You’re dealing with loads of stuff that you can’t change, and people bring in, and they park with you, their problems and their sadnesses,” another said. “They feel better for that, and you feel worse.”
As well as the emotionally draining component of general practice, the doctors also identified workplace culture as being major contributors to poor mental health.
Challenges in practice culture included power politics, bullying among colleagues, shifts spent in isolation – particularly among locums, and a lack of professional and social support.
Doctors reported building distress at their decisions being overturned, abuse from colleagues and higher ups and increasing workloads leading to less time available to connect with their coworkers.
One participant spoke about a colleague who became sick with depression and then died by suicide. While it was “devastating” to the practice, she said there was little time outside of the funeral to acknowledge it.
“It was almost swept under the carpet like, ‘Well, you know, let’s just carry on. Let’s not address what perhaps might have contributed to it at work’,” she explained.
In addition to emotion work and workplace culture, another key factor underpinning burnout and stress among the GPs was the general demands of the job, which included the fear of making mistakes, receiving complaints, the bureaucracy of revalidation and appraisal, and the financial pressures that practice owners were under.
Participants were recruited for face-to-face or phone interviews to understand how and why they sought help for mental illness and burnout and the obstacles they faced.
They were asked to identify themselves as either: living with anxiety, depression, stress and/or burnout; returning to work following treatment; off sick or retired early due to illness; no mental illness. Two out of five participants considered themselves part of the first group.
The UK researchers said that as well as providing more resources to combat increasing workloads, it was “paramount” that general practice addressed its unhealthy cultures.
“Doctors, including GPs, are not invulnerable to the clinical and emotional demands of their work nor the effects of divisive work cultures,” they found, saying their study underpinned the need to improve formal and informal support for those in the profession.
“Collegial support, a willingness to talk about vulnerability and illness, and having open channels of communication enable GPs to feel less isolated and better able to cope with the emotional and clinical demands of their work,” they wrote.
While the emotional element of practice was one of the most draining for the GPs in the study, many also reported the human element as the most rewarding and enjoyable part of their job too, the authors said.
The three most common causes of stress and distress among GPs were:
- Emotional workload: the work invested and required in managing and responding to the psychosocial component of GPs’ work and dealing with abusive or confrontational patients
- Practice culture: practice dynamics and collegial conflict, bullying, isolation and lack of support
- Work role and demands: fear of making mistakes, complaints and inquests, revalidation, appraisal, inspections and financial worries
“GPs are expected to provide their patients with the space, opportunity and permission for them to communicate their concerns and feelings within the consultation, thus enabling individuals to voice and share their experiences and be heard,” they wrote.
“However, the same is not always afforded to GPs.”
BMJ Open 2018; online 11 January