The stress: is it our fault?BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7049.120 (Published 13 July 1996) Cite this as: BMJ 1996;313:120
In the early 1970s, during the battles over the excessive hours worked by junior hospital doctors, my name was mentioned in the press because one week I had worked for 139 hours. This was not just being on call but actually working in an obstetrics and gynaecology department. It was not me alone, of course, but thousands of us. My name was mentioned, but just as a representative of junior doctors. What follows is not me bemoaning my lot as a general practitioner, but I am trying to draw attention to the problem and to tell doctors that they are anything but alone.
Over the years the workload, and thus the stress, in general practice has increased dramatically. This increasing workload should be seen as productivity but has not been matched by increased remuneration, for if it had we could have increased the number of doctors and consequently reduced list sizes. I have found the demands of patients becoming less and less acceptable, but now, fuelled by government led patient expectations, they are inexorable. Over nearly a quarter of a century I have, until this year, had three formal complaints made against me by patients: all were thrown out. These complaints had a devastating effect out of all proportion to their real importance, and I can understand how suicide is sometimes resorted to.
This year I have already had three written complaints, revolving round my having to deal constantly with a stream of trivia. In consequence I find myself becoming irritable when giving considerable time to what is unnecessary health education about minor self limiting disease of short duration and other unreasonable demands on my time. For example: “My child has been miserable for 24 hours. I want him checked before the weekend.” (Not “would like” but “want.”) “I can't get an appointment this morning (never true in our practice) so you will have to visit me.” “My child had a temperature this morning, will you check her over?” “When you visit me today please do not come between 2 00pm and 3 30 pm because I'm going shopping.” We all know the sort of thing.
After the last trivial complaint one of my partners asked if it was my attitude that had resulted in the poor consultation. I dwelt on this: was it true? The thought that it was all my fault after all, that all the stress I felt was self inflicted, played on my mind. I could think of nothing else night or day. I began to sink into a depressive state. My sleep, always poor, became almost non-existent. Food, which I always liked, tasted like cardboard. I stopped my fitness training, I stopped working at my hobbies, and I felt sick driving to work. My secretary tells me that I have stopped smiling, and apart from becoming a worse parent at home I am sure I am becoming a worse doctor as well.
Finally, I thought about a cry for help. But if I took a minor overdose to draw attention to how I was feeling everybody would know that it was not a real attempt, for with myknowledge how could I get it wrong? No, it would have to be formal psychiatric help or a proper overdose. How do you choose? Where will I find the courage to admit that I cannot cope any longer and see my own general practitioner, and if I do will he judge how desperate I am? The worst part is, if he tells me to take some sick leave I know that I will not dare to do so for if I stop I shall never be able to face it all again.
Recruitment to general practice is becoming a problem. Ten years ago there were up to 100 applicants per position; now there are fewer than 10. Where have all the doctors gone? If they have any sense it will not be into general practice.
The BMA has set up a counselling service, but I think that the government should act to make this unnecessary. Or is it all our fault?