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A good day

Still practising

Chris Preece

Friday, 05 April 2019

AdobeStock_91502398_GoodDay_blogv2.jpgSomething remarkable happened to me the other day. It seems like a small thing to report, and yet it was a revelation. It was, simply, this – I had a good day. It was nothing spectacular, not a day to be boasted about, or to be recorded in song for posterity. Just, you know, a good day.

It was one of those days where I felt I’d properly addressed all the problems that I’d been confronted with, despite some being genuinely challenging. A day when work was constant, but never too much. It was the kind of day, where you pack up your bag to go home and realise that you’ve managed, in your own small way, to make the world a better place. It felt unbelievably good.

Up until then, I had started to think that such days were a figment of my imagination. I was fairly sure that they’d happened before, but the longer I went without one, the longer I started to doubt my own memory. Perhaps it had always been like this? Perhaps every day was simply an onslaught of managing the impossible, an endless stream of tiny compromises that left me with the persistent nagging thought that with a bit more time, a bit more energy, a better system, then I could do better.

It’s a draining feeling – the sense that no matter how hard you try, you’re never quite doing enough, that you are, on some level, failing someone, somewhere. The idea that you’ve joined a system to help others that is somehow inherently designed to make achieving that impossible. On a bad day I imagine Sisyphus looking across at me and returning to his rock pushing with relief.

Too many of those bad days and I can almost feel the empathy draining out of me, and I become terrified that my compassion has become a well-rehearsed dance rather than any reflection of inner truth. I find myself anxiously considering what’s wrong. Am I broken? Am I burnt out? Am I (whisper it) lacking resilience?

Ah, yes, resilience. The keystone word of our age. The ability to cope with a crisis and then magically bounce back to pre-crisis state rapidly. A property that all future medical students are instructed they must demonstrate in spades should they have any chance of training at all. There are scores you can do. You can go on courses to learn how to improve your resilience. It’s now so pervasive that it’s baked into the GP Forward View.

Whilst the more enlightened takes on the subject of resilience focus on changing the cultural and structural issues that lead to its erosion, much of the rhetoric around it seems to focus on the individual. “If only we can improve the resilience of individuals in the health service, then everything will be alright”, with the barely concealed sub-text of “it’s not that our system is broken, it’s that you’re not strong enough”.

This approach to resilience is akin to a restaurateur blaming their clientele’s food poisoning on their immune systems. The truth is, even the most robust digestive tract in the world is going to struggle if all you ever feed them is the content of the sewage outlet.

It does seem like the NHS is increasingly guilty of demanding resilience whilst doing little to enable it. For instance, the Doctors’ Association UK recently put a spotlight onto junior doctors who had leave requests rejected after requesting time off for such apparently trivial reasons as ill health, bereavement or their own wedding. You might imagine that an organisation already battling with over 100,000 vacant posts would be trying to do more to support its staff, but seemingly not.

Of course, it’s not just the NHS that seems to have adopted the “fix the individual, not the problem” approach. Indeed the prize for “Most Uncaring Solution to Work Force Pressures” goes to the Education Sector where, back in 2017, the Leigh Academies Trust introduced a form of Electro-Convulsive Therapy for its teachers to relieve the insomnia, anxiety and depression that was resulting from their job. To be fair, this was “alongside mindfulness and examining the workload of the staff”, but if you’re having to give your staff ECT just to get through the day, perhaps there’s something inherently wrong with their work environment?

Except, of course, the only thing remotely surprising about that story on reflection is the treatment offered. There were 595,000 cases of work-related stress in 2017/18 alone. (That we know about.) Whilst most of those people were presumably not offered ECT, I suspect a large number of these individuals were offered treatments to “fix” them in lieu of addressing the true underlying cause.

It’s hard to know, as a humble GP, how to shift the focus from curing individuals to healing the sickness that seemingly pervades our entire culture. The first step I guess, is to get one’s own diagnosis right, and it’s incredible what a difference one good day can make.

The sudden and certain realisation that the problem wasn’t me served as a massive relief. Given the time and space, I’m the doctor I want to be, and where possible the one my patients need. My very next surgery was packed with impossibly complex patients, but the spirit of that One Good Day saw me through nicely. Because that’s the thing with “resilience”. You can only assess someone’s ability to bounce back from a crisis if you occasionally allow the crisis to abate.

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Chris Preece

Chris has worked as a GP Partner in North Yorkshire since 2004, and still relishes the peculiar challenge of never quite knowing what the next person through the door is going to present with. He was the chair of his local Practice Based Commissioning Group, and when this evolved into a CCG he joined the Governing Body, ultimately leaving in April 2015. He continues to work with the CCG in an advisory capacity. When not being consumed by all things medical, Chris occupies himself by writing, gaming, and indulging the whims of his children. He has previously written and performed in a number of pantomimes and occupied the fourth plinth in Trafalgar Square. Tragically, his patients no longer tell him he looks too young to be a doctor.
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