DOCTORS’ SELF-CARE

Up in the air
PAUL HAYES

Maintaining a balance between

work and other areas of life is never
easy for GPs.

Images Thinkstock; RACGP

10 Reprinted from Good Practice Issue 12, December 2017

Just one more patient; one more committee do that in the early years to consolidate and get
meeting; one more phone call; one more your vision for the practice embedded.
case study. ‘But that does become easier with time if you
It is easy for doctors to keep adding that have the processes in place.’
‘one more’ thing to their day. There is, after all, With no previous experience in the business
always something else to do. and administrative side of general practice,
What many GPs seem to discover, however, Dr Mullins faced something of a steep learning
is that doing that little bit extra can be a slippery curve when she assumed control of her
slope and, before they know it, it is all getting practice. The need to undergo accreditation
on top of them. almost immediately was a baptism of fire, but
‘I have experienced being burnt out and being with experience – not to mention more doctors
depressed. I think that we don’t really realise it on hand in the practice – life has become
at the time,’ Dr Jonathan Ramachenderan, a more manageable.
procedural GP anaesthetist, told Good Practice. But that does not mean, according to
‘We think we’re doing quite well because we’re Dr Mullins, the scales are always in balance
doing good things, helping out by maybe doing for each and every day.
research, being involved in committees, working ‘I am a bit more confident about the
hard towards a certain qualification. processes and have things set up better, but it
‘At the same time, we’re being stretched by is a constant reflection process of “am I getting
our families because we may have young kids, exhausted?”’ she said.
or may be going through a difficult period in Dr Mullins has certainly managed to get the
our relationships. types of processes Dr Sharma mentions in place,
‘So [being burnt out and depressed] pushed but that is not to suggest her typical day is an
me into revaluating what was important. I was easy one. Actual time with patients – time as a
working too much and I was chasing after the doctor, not a business owner – is scheduled in
wrong things. Being distracted by this committee, the same way as everything else.
that research, trying to be all things for everyone.’ ‘I tend to get to work about an hour before
Given GPs are pulled in so many different everyone else and run through the emails and
directions by so many forces, difficulty in things that have come through, then have a
maintaining this type of balance is nothing new for chat with the practice manager about any other
those in general practice. The point was clearly things that have come up,’ she said. ‘Then I
illustrated, however, in the RACGP’s recent will look at all of my results, and I overlook the
benchmark report, General practice: Health of the registrar results. If the other doctor is away I will
nation 2017, which provided an often-fascinating check her results.
snapshot of Australia’s current state of patient ‘I then dedicate time for seeing my patients.
access to general practice, the role of the GP, It’s pretty straightforward but, as often happens
and the broader general practice workforce. through the day, I check my emails and try to
Among one of the report’s more eye-opening respond to things quite quickly. >>
insights was the fact that 64% of GPs cited the
difficulty in maintaining work–life balance as the
key issue when running a practice.
‘Sometimes there is a little delay in that where
you realise, actually, we are quite busy and
I am struggling to fit it all in,’ Dr Columbine
Mullins, GP and a sole practice owner, told Good
Practice. ‘It’s about acknowledging that and
making changes.’

Work–life health
In the case of those who run a practice, an initial
lack of knowledge in the general day-to-day of
owning and operating a busy small business is
usually among the main culprits in tipping the
work–life balance in the wrong direction.
‘Early on, yes, I worked a lot harder in my
practice than I do now,’ Dr Rashmi Sharma,
Long-time GP Dr Rashmi Sharma worked harder as a new
who has been a practice owner for close to two practice owner, but continued growth and better workplace
decades, told Good Practice. ‘I think you have to strategies have helped to create a better balance.

Reprinted from Good Practice Issue 12, December 2017 11

DOCTORS’ SELF-CARE

>> ‘If I do that the work gets done, if feels it is important to acknowledge that lack community, you really do need to design those
not it tends to get left. So the day is often of balance and devote time to one and then self-care strategies for yourself and employ
interrupted by bits and pieces like that. the other, instead of trying to spread yourself them every day.
‘If I have big projects or things that need across both and be all things to all people. ‘It’s not something that can be haphazard
to be sorted out, often I will try and hold that ‘It’s a work–life imbalance because you but I think it needs to become a habit. I firmly
over until the Tuesday, when I am not clinically either choose one or the other, you can’t believe that it needs to be built into your day,
seeing patients. choose both. They both require a great deal if not week, if not month, if not year. I think
‘I will often spend a little bit longer working from you,’ he said. ‘When you have young it’s our responsibility.’
in the evening on things like payroll and bills; kids, for example, you might choose that first Upon realising he had ‘fallen into a hole’,
I like to oversee all of the stuff like that. There and that means being home at a certain time, Dr Ramachenderan resolved to make some
is always extra bits and pieces, like contracts not having meetings after a certain time, and meaningful changes.
and things like that that come up. saying no to a lot of things. ‘I was just living a very distracted life,’
‘It is a bit of a juggling act.’ ‘Then when that period is over, it’s starting he said. ‘I didn’t pass my Fellowship by, I
up again to accepting more different things.’ think, 0.5% and that pushed me into a hole
Family health As a single parent, Dr Mullins is able because I had to re-evaluate my life and say,
If life as a GP is often a juggling act, it stands to examine her work–life balance in the “Why did this happen?”
to reason that family would represent one of context of her son. ‘As a result I simplified everything and
the balls in the air for many. ‘I think you just have to keep reviewing realised that I needed rest. I decided that I
With the needs of patients and, by how you are going – for me, that is how my needed to work a nine-day fortnight and try to
extension, a practice so often assuming pole son is travelling – pretty frequently because always have Saturdays off for my family and
position in the race for a GP’s time, family is it’s quite easy to get caught up in work,’ just to replenish myself.
a common casualty. she said. ‘I think it is a really big challenge ‘What I did was really take a sabbath,
‘If you make yourself available there’s because you can start to get it wrong, get I rested and didn’t do work things. That
always going to be people to see who you the balance not quite right, quite quickly.’ really helped.
feel really need you. And it’s hard to say ‘But as well, the physical care was always
no or to get them to see someone else,’ Self health really important – exercising was a big thing
Dr Mullins said. ‘I have become better at While Dr Mullins tends to maintain her own for me. The routine that I have at the moment
setting boundaries and allocating time. balances with detailed schedules, timetables is really good for me, getting up very early,
‘I have realised, for example, I haven’t and the like – ‘I love my diary,’ she said – spending time by myself exercising, then
been taking my son into his classroom, so Dr Ramachenderan takes a different, but doing something I love like writing or thinking
I am making changes to my diary so I am no less structured, approach. or reading, and then re-engaging with
taking him into class. Whereas, before I ‘It’s not really about balance but more the family. Going through that routine has
was dropping him off and rushing off to see about self-care,’ he said. ‘Being a doctor really added value.’
the first patient. means having intense human interactions More dedicated time with his sons has also
‘But it’s very easy to put pressure on and learning about people’s secrets and been key in restoring himself.
yourself to drop everything for your patients.’ their difficulties, and being put in very ‘I take my sons out every Saturday morning,
When it comes to having a family, stressful situations. one at a time, and I encourage them,’ he said.
Dr Ramachenderan, who is married with ‘I think that to be able to do that over a ‘I can’t do that every day, but in the time that I
three young sons, doesn’t actually believe in long period of time, being a GP especially have I try to maximise my encouragement and
the idea of a work–life balance. Rather, he because you’re quite intimately involved in a connect with them.’
Dr Mullins has also made efforts towards
greater levels of self-care, but admits it can
sometimes be difficult.
‘I feel there is always this tightrope
to walk as far as making sure my son is
getting enough attention and input, and I am
getting whatever work needs to be done,
Images RACGP; Jonathan Ramachenderan

done,’ she said.

Encouragingly, Dr Mullins’ efforts to make
more time for herself and her son have
been met with considerable understanding.
Her patients, it seems, appreciate that she
is indeed human.
‘They are often the first people to say, you
need a holiday, you should go and do this
with your son, or whatever,’ she said. ‘There
From left: Dr Columbine Mullins has found patients to be understanding when discussing taking some more time for
herself and her son; following his exeriences with burnout and depression, Dr Jonathan Ramachenderan implemented a has been a lot of goodwill from patients in
number of self-care stratagies that he found ‘really added value’ to his own wellbeing. that regard.’

12 Reprinted from Good Practice Issue 12, December 2017