Why I . . . use CBTBMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5650 (Published 23 September 2019) Cite this as: BMJ 2019;366:l5650
Combining doctors’ communication skills with cognitive behavioural therapy (CBT) can help clinicians improve patient care and boost their own wellbeing, says Lee David.
The GP trainer and CBT specialist combines GP work with practising as a CBT therapist, and teaching, writing, and research.
She hasn’t had a conventional career path; not long after qualifying as a doctor in 1996, David decided to take a gap year which included a voluntary post as expedition medic in Chile with the charity Raleigh International.
“I decided to do some travelling which included canoeing down the fjords in Patagonia,” she says. “It was a great experience after the stresses of being a junior doctor. It was a way of taking some time back for me and reconnecting with who I was as a person.”
While doing her GP training in Oxford, David’s course offered her additional funding to develop a special interest. “I’d always had an interest in psychology and CBT in particular,” she says.
“For me, it connected with how I look at my own life, my own problems, and my family, and made a lot of sense to me. It seemed relevant to what I was doing as a GP.”
David believes that both doctors and patients benefit when CBT is used in the general practice setting, saying, “After my training, I did a masters in CBT. During my GP work, I realised I was improving my ability to understand people and developing new ways of explaining things for people who were trying to change difficult aspects of their lives.
“It’s about caring for a patient as a unique person and not just a number or a checklist—looking at what is going on for this person in front of you and taking time to establish that connection and find out a bit about their life story. It makes everything more interesting and work more rewarding.”
In 2007 David formed 10 Minute CBT, an educational organisation providing face-to-face and online postgraduate education for GPs and other primary care health professionals on how to use CBT in routine consultations to improve patients’ physical health and emotional wellbeing.
Since it began, the service has trained thousands of GPs from across the globe including Ireland, Norway, and the US.
“A lot of the work that we do in general practice involves some element of mental health,” David says. “The more skilled we are in dealing with it, the more effective our consultations. It’s not about burdening GPs, but freeing them up and giving them the capacity to deal with more, in a way that lifts the load.”
She adds, “GPs have amazing communication skills and people share things with them. With a sea of overwhelming information you often don’t know where to start, using CBT gives you a framework to structure the information.”
Using CBT has helped David’s own wellbeing, she adds. “I use it on myself all the time. Doctors and other health professionals can be very hard on themselves, so using simple but genuinely effective strategies, using compassion, and making small changes in our behaviour make a huge difference to our wellbeing.”
CBT and general practice can work well together. David says, “I would never want to leave general practice—it’s my heart and soul—but CBT comes alongside it. They complement each other well. It weaves into the way I do general practice.”
How to make the change:
Start with some self care and use it at a time when you’re feeling stressed
Choose to start using CBT in patient consultants when you are a little less under pressure
Focus on bite sized or “micro” behaviour changes rather than seeking one big change to completely fix a problem
Build a partnership and plan homework to encourage the patient to take responsibility for understanding and overcoming their problems.