Turning off the road to burnout

Complaining can feel better than changing, but only in the short term.

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So many female GPs are burnt out.  

More and more are leaving and finding solace in female-only groups of burnt-out GPs to debrief and commiserate.  

And yet … as we no doubt know, too much moping tends to provide the dopamine that obstructs actual change.  

In the first decade of raising my four babies solo, while training fulltime and studying for examinations, I coined the term “sitting on my pity pot” when I’d really, truly had enough and needed to feel sorry for myself.  

I set a time limit for the pity pot because I was aware, even then, how easy it would be to slide into permanent residence there, blaming life for my woes.  

As with parenting, those 14+ years of life were some of the hardest and most rewarding years that I never want to go back to. They taught me so much, mostly through suffering, grief and lessons learned the hard way.  

I was reminded of that this week, when I terminated a therapeutic relationship with a patient after prior warnings.  

One of my receptionists was verbally abused by the spouse of a new patient who’d rung to make an appointment and threatened because we take a deposit to confirm all new appointments.  

Another patient cancelled late and per policy was not allowed to book till they’d paid the late fee. They had arguments with staff over it, ending with “I don’t know why I have to keep coming back when nothing is updated or actually changes at the appointments!”  

Commoditisation of medicine is at an all-time high.  

People believe that all we are doing is simply signing forms – “so what is the big deal? It’s not brain surgery!”, neurosurgeons being the only health practitioners still retaining the public’s respect, it seems.  

I’ve had people argue about why they need to pay for a consultation if the script doesn’t change, if no updates are being made, if they want telehealth only. 

I’ve had others argue about the late cancellation fee with reasons ranging from “the dog ate my homework” to “I booked a 30-minute appointment and cancelled, but I want to rebook it as just a standard 15-minute consultation, so why do I have to pay the late fee?”  

The mind boggles.  

So all this week I’ve reiterated to all patients, new and existing, the late cancellation and reschedule policy and verbally documented their consent and acceptance.  

I’ve decided that the patients who don’t value my expertise, and who see the script as simply a signature on a piece of paper, would be better off finding someone online who’ll fulfil their order at more competitive prices. I have been discharging them from clinic with my best wishes.  

When resentment creeps into the clinic, it is a sign to address the issue, or to agree to part ways. I cannot control your behaviour but I can control mine. And boundaries are my attempt to continue a relationship with you.  

These things have been playing on repeat in my mind the last few weeks. Why?  

Exhaustion and resentment are doorways to burnout. Yet I am not a victim, nor am I powerless.  

I have the ability to say no.  

Things are not done to me without my consent. 

It may annoy some and anger others, but their reaction is not my responsibility as long as I am not being rude, mean or unethical.  

Far too many of us in health believe it is our job to alleviate all distress and discomfort for our patients, when they are usually adults who are capable of managing their own lives and make daily choices that lead to consequences that they may or may not like.  

Barring the truly vulnerable groups, it is not my job to rescue any of these people from the consequences of their choices – nor is it yours. That belief is at least in part responsible for the high rates of burnout we see in general practice, especially among female GPs.  

The solution – to learn effective boundaries – is unpopular. In groups, women get angry when this is suggested. “It’s not that easy”, “Easy for you to say” and “I can’t, I’m too soft-hearted” are among the common rebuttals.  

Psychologists call this the “yes but …” response.  

A patient says an issue is distressing, and then shoots down every single potential solution presented to them with a “yes but …” as to why it won’t work. They don’t intend to make the change because, for now, continuing to give in to the behaviour serves a purpose that is more rewarding than the pain of change.  

In my psychotherapy work I explore this with my patients. And in my articles and in groups, I attempt to nudge these people into mulling their payoff for remaining and doing more of the same.  

Ultimately, we cannot change how anyone else behaves. We can only determine what behaviours are unacceptable to us and then communicate our rules around them effectively, so that if they’re breached we have the option to remove ourselves from the equation.  

I’ve worked really hard to build a practice that I am proud of, one that is almost entirely private billing so that it allows me to be profitable and to donate my time and skills for free when and where I choose. My patients are people I genuinely like and am invested in, as much as they are in the therapeutic relationship we have together.  

So, when someone comes along who is clearly not a fit because they find my policies unacceptable, I suggest I am not the doctor for them, so the next person who will appreciate the relationship can step up.  

In years to come, as our numbers dwindle and good GPs become even harder to find, we will have our pick of who to work with while charging appropriately and choosing to do pro bono work elsewhere if we wish.  

Lean into it, enjoy it and practice effective boundaries till then. There are no coincidences, only choices and habits that lead to success or failure – and burnout. 

Dr Imaan Joshi is a Sydney GP; she tweets @imaanjoshi.