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During the many years that I’ve worked as a GP at the frontline of the NHS, I have lost count of the number of cases of work-related stress I have encountered. But David’s case (name changed) sticks in my mind. A highly capable lawyer with an outstanding academic record, David landed up in my surgery one Monday morning in crisis. It transpired that there was a tangled web of stressors which had brought David to this point. Some were related to the gruelling workload associated with being a trainee in a prestigious corporate law firm, the systemic long-hours culture, poor manager support and lack of recognition thrown in for good measure. But, as is normally the case, there was also some non-work-related stress in the mix as well which was also taking its toll on David’s mental health. After a long consultation, we agreed to arrange some talking therapy and I supported David with a sick note and regularreview and happily, after a couple of months David successfully returned to his previous role with a phased return and some appropriate reasonable adjustments.But David’s case had a profound effect on me. For several weeks, a combination of burnout coupled with the debilitating symptoms of anxiety and depression had made him doubt whether he could ever return to the career he loved. It was a seminal moment, a line in the sand, a watershed moment for me as a GP. It touched a personal raw nerve because I too had experienced severe burnout during my first year as a newly qualified doctor. In the days long before the European working time directive had come into force and in an era when all junior medics were called “housemen” irrespective of gender, I regularly worked a 90+ hour week. Stress and exhaustion were constant companions. Five years of medical school felt nowhere near adequate to deal with the life and death decisions that had to be faced daily.
This was coupled with chronic sleep deprivation, lack of effective recharge, and riding a blood sugar roller coaster which was fuelled more heavily than intended by the thank you chocolates donated by grateful relatives on the wards. After a particularly gruelling weekend on call, I broke down in tears at the end of a 56 hour shift and couldn’t return. Just like David, I had “burnt out”. Burnout is technically an occupational syndrome, the catastrophic end result of severe work-related stress. The World Health Organisation has recently updated its definition to include exhaustion, feeling detached from and/or feeling negative towards one’s job and reduced professional productivity. It may precipitate and co-exist with a diagnosable mental illness.But can you imagine how crass it would have been if my supervising consultant had told me to hang on in there because it was “free fruit Monday” and there was a mindfulness session for all staff at lunchtime. When I tell this story, people laugh at the sheer stupidity of this suggestion. And yet in my experience, too many organisations take a similarly tokenistic approach to wellbeing and engagement. They fail to understand the inter-relationship between their organisational culture and work environment and favour solutions that are superficial or push the issue to individual employees to “fix”. Instead of focussing on a datadriven approach which uncovers the real pressure points in their organisation and identifying evidence-based solutions to sort them, they fall for the “fluffy” stuff which sounds laudable but won’t fix the underlying issues.
Research shows that medicine and law both attract more than their fair share of individuals with so-called Type 1 behaviours: impatient, competitive, ambitious, needs recognition, driven – sound familiar anyone? In both professions there is a growing awareness of burgeoning mental ill health and rising stress levels and the medical press frequently write about doctor resilience. In both law and medicine, we have to resist the insidious message that puts the onus the individual to be more resilient whilst working in unhealthy cultures. Because, as both stories demonstrate, any capable professional can experience burnout within the wrong work environment. No worker is completely immune.Providing support for David forced me to reflect again on my personal burnout story which very nearly led me to quit medicine. It gave me new-found determination to get upstream of the end-stage issues caused by work-related stress that I see several times each week in my surgery. I decided to help organisations take a proactive and pre-emptive approach. Not just to avoid the fall-out and hit to their bottom line from negative outcomes like stress-related absence, poor mental health and attrition (and by the way it currently costs upwards of £50,000 to train a lawyer in the UK) but rather to take the science of how our bodies and brains function best both in and out of work to equip individuals and teams to work in healthy ways to truly improve sustainable performance.
Dr Sarah Hattam. Director, Concilio Health.
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