'˜Scotland's GP burnout now an epidemic', says Scots doctor

Dr Punam Krishan writes: I am a GP of six years and I recently resigned from my partnership after a catalogue of challenges which caused me to burn out and I now work as a locum.

Doctor Punam Krishan. Picture: John Devlin
Doctor Punam Krishan. Picture: John Devlin

I studied for ten years to become a GP. I cannot describe the pride I felt when I received my certificate of completion, achieving my life-long goal. I never imagined that six years later, I would burn out because I cared too much and worked too hard.

“Burnout” is a state of emotional, mental and physical exhaustion caused by unresolved, excessive and prolonged stress. It occurs when you feel overwhelmed and emotionally drained as you try, but fail, to meet the constant demands put upon you.

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Doctor Punam Krishan. Picture: John Devlin
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This defines the mental state of the majority of GPs in Britain today. This is the GP you saw yesterday or will see tomorrow. This is the person behind the desk whose job it is to take care of you, to manage your healthcare.

On that note, let me re-live with you a day I had two years ago. A day that is fairly “acceptable” in GP land. I remember it vividly.

“You can never get an appointment here anymore, it never used to be like this!” a patient complained to the receptionist. This was something my staff were used to hearing.

He was given an emergency appointment and sat impatiently in the waiting room. I was running late and this irritated him, so he complained again. I received messages on my screen about how ­disgruntled he was, while I tried to concentrate on the patient sat before me whose husband had just passed away. I could not rush her.

My patients could not know how tired I was that day. I had not had much sleep the night before and I was anxious because my young son was unwell.

I had to leave him because I had a duty of care to my patients. I knew how busy my day was with patients who had been waiting for weeks to see me. Some had changed work schedules to make their appointment. I was on my own and my colleague could not help out. I could not call in sick.

I had no choice but to give my baby paracetamol and ibuprofen, drop him at nursery and drive to work with the heaviest of hearts, praying he would be OK. I felt I had let my son down. But as always I felt I could not let my patients down.

I remember rushing to work and seeing patients walking into the practice. I smiled and they waved back, oblivious. As I ran in, my admin staff told me of several urgent messages. There were emergency home visit requests and a bundle of acute prescriptions requiring my signature. I had an urgent call to make to the specialist cancer nurse to discuss a terminally ill patient. All of this before I began my surgery hours at 8:30am.

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My patients never see this behind-the-scenes chaos; what they see is a smiling GP who sits them down and gives them their utmost attention.

That particular day, I knew how disgruntled that male patient was having waited for 30 minutes. I remembered to ask him about his holiday and his mother while dealing with his emergency “tickly cough”. He left happy but unaware of the panic I was feeling inside. He took 20 minutes of my time, even though I only had ten minutes to give and I could see from my screen that there were another three patients waiting outside my room, also disgruntled at having to wait.

I continued my morning like this, reviewing patient after patient for three-and-a-half hours. I had no breaks, no time to go to the toilet, no time to grab a coffee.

The surgery closed over lunch but having finished late, I had little time to do anything, including eat.

I returned the call to the palliative care nurse and arranged a home visit; my dear patient’s death was imminent and I needed to see him. I had another visit to do for an elderly housebound patient who had fallen. As I tried to rush out, my receptionist told me of an urgent repeat prescription request for a patient who was going on holiday and had forgotten to reorder their medications. To say I was harassed is a mighty understatement but I did it and ran out the door.

As I drove to the first house visit, I called my son’s nursery. They needed me to collect him because his temperature was not settling and he had been sick. I was helpless. I could not leave work and could not go to pick up my son.

My husband, also a doctor, was operating and I could not get hold of him. My colleague was on annual leave. I called my mum in a panic and she left her workplace to go and collect my baby so that I could continue my duty of care to patients.

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As a doctor, our careers often end up affecting our families and personal lives. We have an inherent sense of commitment to our work.

Sadly, our families pick up the pieces with great frustration and sacrifices which often damage our personal relationships.

I finally reached the home of my dying patient. I was very fond of this man and had known him since I joined the practice. His daughter was understandably distressed. She needed support and some counselling. Though she was not my patient, I could not leave her in this state. We spent time sharing stories. I did all I could to ensure he would remain comfortable. It was time well spent, for I never saw them again.

I drove back, arriving 15 minutes late for the next surgery. I remember the disappointed look from my waiting patients as I ran in. A further bundle of prescription requests awaited with some hospital discharge letters to action – along with a sympathetic cup of tea and biscuit from my nurse.

During the relentless afternoon, I received a message about a concerned parent. I asked them to bring their child down at the end of my surgery at 6pm. With everyone dealt with, I tackled the pile of prescriptions, telephone consultations, referrals, hospital letters and test results. I finally left at 8pm that night.

Deflated, hungry and exhausted, I drove home. I remember feeling sad about my dying patient, about all the cases I had seen that day and the panic about whether I had missed anything in the hustle of it all.

I arrived home to my crying baby who had developed a rash with a high temperature and I fell apart in my own mum’s arms.

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This level of demand continued for two years as I tried to be a GP, a practice manager, a mother and everything else everyone needed me to be. I hit burnout last year.

An epidemic is upon us and the outlook is grim. It is affecting the young as well as the old, causing them to drop like flies. With crippling exhaustion but a strong will to care, they soldier on, day in, day out, again and again until they eventually burn out. This is the reality that your GP is facing today.

The next time your GP is running late, please know they are not doing it deliberately. They are desperate to go home on time as they have families too.

“We want to work as efficiently and as best as we can while ensuring that we do not make any clinical errors that could cause harm. Our job is to look after you and we have your best interests at heart.

Be kind to us. Be patient with us. We need your support as much as you need ours. Don’t let us burn out.