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Abstract

Growing work pressures in the NHS are negatively affecting GPs’ wellbeing. Research has found half of GPs are experiencing burnout - a state of exhaustion caused by excessive and continuous stress. In this study we aimed to understand what it is like to experience burnout as a GP. We conducted interviews with six GPs who had experienced burnout. These were analysed using interpretative phenomenological analysis - an analysis method which enables us to explore shared and unique experiences while understanding how GPs made sense of burnout. Four main themes were identified in this study which are presented in this art-based booklet.
Experiences of GP Burnout:
Findings from an Interview Study Paired with Art
Research by: Philippa Shaw, Dr Tina Catwright, Prof Damien Ridge, & Prof David Peters
Art by: Eddie Tucker & Gillian Tucker
The gradual onset of burnout and the feeling of being broken.
Being trapped within an ill-functioning organisation, and feeling torn
between their responsibilities and their wellbeing.
The resulting vulnerability which distorted how they saw themselves
as a doctor.
Navigating burnout by trying to understand their experience and the
ongoing impact of burnout.
Background
Growing work pressures in the NHS are negatively affecting GPs’
wellbeing. Research has found half of GPs are experiencing burnout - a
state of exhaustion caused by excessive and continuous stress. In this
study we aimed to understand what it is like to experience burnout as a
GP.
Methods
We conducted interviews with six GPs who had experienced burnout.
These were analysed using interpretative phenomenological analysis -
an analysis method which enables us to explore shared and unique
experiences while understanding how GPs made sense of burnout.
Findings
From the analysis, we identified four main themes:
1.
2.
3.
4.
A Wider Audience for the Research Findings
We hope that many people read this summary of findings as
research has found GP experiences of burnout are infrequently
reported in media and research, and that there is poor
identification and support of burnout in GPs.
Art from the Findings
One way to increase
engagement with research is
pairing findings with art.
Research suggests art can help communicate research whilst
creating dialogue and raising awareness.
Therefore, two artists worked with summaries of themes to
produce pieces of art. One piece of art was created for each theme.
This Booklet
Over the next few pages you can read a summary of each theme
written by the researchers, with quotes from the GPs interviewed.
Pseudonyms have been used instead of participant names.
These summaries are presented with a photograph of the art and
comments made by the artist about their artwork.
The Research Behind
'Experiences of GP Burnout'
Turning Interview Findings into
Pieces of Art
This theme explores GPs feeling broken and having reached rock
bottom, whilst their organisation was crumbling. The NHS was seen
as an organisation the participants had been moulded by, and
dedicated years of their lives to, yet on reflection this was also an
organisation which is felt to be cold and uncaring.
“There is just multiple examples to show you the healthcare
[organisation] doesn’t care about you and I think that really
crushed me more than anything, and added to my stress and
this burnout, and it is just the fact you have dedicated your life,
tears, sweat.” Rachel
“I am a pawn in this big game, I am a worker, I think I am a
worker, I think I am the leader and I am good at systems change
and I am going to make things happen, and then I think, 'no I am
not, it’s a game'.”Saima
This theme explored how participants viewed their work in relation
to the gradual onset of burnout.
“I think over those four months it just gradually wore me down
and my resilience was just zilch. Kate
It also captured the defining experiences of exhaustion and the
overwhelming impact of burnout on all aspects of life.
“It is global, because it affects everything, it affects how I am with
my work, it affects how I am with my family and friends, and then
it affects me and how I feel about life and whether I am enjoying
life.” Beth
Theme 1: Being Broken in a
Broken System
Art by: Gillian Tucker
This piece embodies the worn down GP. This shows a wreck of a
human inside the ill-functioning NHS. I decided to portray the
organisation gradually sinking, taking with it everything that is
inside.The sketched GP consultation room tilts towards the ocean
floor. I use the smooth ocean-tumbled seaglass for the ocean to
show fragility in life. The broken GP falling slowly to rock bottom.
“I hadn’t really noticed that it [myself] was broken before.” Lucy
Theme 2: Trapped and Conflicted
This theme captures the GPs’ feelings of being increasingly pushed
away from their work, desperately wanting to escape, to take
time off, to get help or leave the profession, whilst being pulled to
remain in work, held there by both internal and external pressures.
"I think I just felt trapped, that I couldn’t change it, and yet I also
felt like I couldn’t leave.” Lucy
"I always wanted to escape, to get away from it and I remember
thinking in the mornings ‘actually no one is making me go into
work, I don’t have to go into work, I don’t have to go into work’.
Kate
The GPs described continually weighing up their potential options.
There were key differences in experience between participants.
Some continued to feel trapped while others were able to seek
help. Saima remained trapped.
“That’s how I feel, I want to leave every day, can I say that on
there [dictaphone] … {whispers} I want to leave every day, every
day I think this is just not right {pause}.”Saima
Kate, Beth and Lucy were able to seek help and take time off, yet felt
guilt and worry as a consequence. John and Rachel’s circumstances
allowed them freedom to escape.
“I remember thinking maybe I will just end up selling ice cream on
Bondi beach because I don’t mind, I will follow any likely
path.”John
Nevertheless, all described feeling isolated, misunderstood and a
reluctance to acknowledge their experience and seek help.
Art by: Eddie Tucker
The person in the drawing huddles to protect themselves. The body
has been constructed using GP quotes, but the shape of the mouth
is made by shading, as these experiences are often unspoken. The
shadows from the broken glass act as bars to a cage - keeping
people out who could help, as well as trapping the doctor inside.
“I am a social beast and just to be stuck you know in that room, you
are doing good you are seeing patients, but patients are completely
different to your social life, there is a barrier. Rachel
Theme 3: The Meaning of Self
How GPs viewed themselves highlighted the complexity in
experiences of burnout. All participants felt strongly connected to
their professional identity, part of which was a strong work ethic.
“That is how we are reared, not just from university but from
school, that is how we are reared ... automaton robotic
programming, that’s how we are programmed. Rachel
The nature of their professional identity led to the prioritisation of
work over their life outside the role, adding to the challenges of the
role.
“[It was like] things dropping off at each level until it was just
phurrf losing other little bits of yourself along the way.” Lucy
All gave their last reserves of energy to maintain the quality of care.
“I was trying to make sure that I cared for patients... but it was
much harder to do that because it came at much more cost to
me, a lot more cost to me because I hadn’t got the energy and the
concentration that I needed to have.” Beth
But perceptions of their key role as a GP acted to prevent them
from taking sick leave in a timely way, leading to exacerbation of
symptoms.
“It is that belief in that superhuman doctor that actually makes
the system run... you have almost got to keep that game up.”
Saima
The experience of burnout was incompatible with their expectations
of themselves, leading to the feeling that they had lost their identity.
“What the hell is wrong with me? Why? Why can’t I deal with this?”
Kate
Art by: Eddie Tucker
The broken mirror symbolises the splitting between the GP and their
reflection. There are two separate manifestations of the person
their public face and their inner identity. The gloom and darkness in
the work is symbolic of the inner turmoil and building pressure
within the doctor before a storm breaks.
“There’s no better role in a way than helping someone physically or
mentally …. I think that yeah that’s ultimately that’s why I locum.”
Kate
Theme 4: Navigating Life After
Burnout
This theme explores the period after participants accepted their
experience of burnout. Some participants decide to take time away
or seek help.
“I thought ‘oh I can justify it now because I can’t function, and I
am literally hitting rock bottom’.” Kate
Participants described how their perceptions changed through
different points of their recovery journey, and the reality for some
that the consequences of burnout will remain with them indefinitely.
With this acknowledgement of vulnerability came the need to
prioritise their own health.
“I think it is now time to think about myself.” Rachel
“I suspect I will be a locum for the rest of my working life which I
am sort of coming to terms with.” Beth
While also wanting to reclaim who they are.
“I want my own life, I don’t want my life to be so much of this NHS
world.” Saima
However, for some GPs their understanding of their experience had
some positive outcomes.
“I am now a lot more understanding when it comes to patients
when it comes to mental health, and I think they know that, and I
get a lot of patients who come back because I can now
understand." Kate
"it was [whilst travelling] where I just fell back in love with life."
John
Art by: Gillian Tucker
The lotus for this piece represents self-regeneration, whilst the sea
brick represents the murky waters the GPs have their roots in. The
steel used has good resistance showing the GPs' strength to return
to work. However the wire is also malleable showing the GPs'
changing perspectives - their increased awareness and acceptance
of their vulnerabilities, now prioritising themselves.
“There’s need to be something put in place ... that teaches that this
is the challenges you are going to face and actually it is fine to
admit you are suffering, this is where you get help. Lucy
With this booklet we are trying to distribute research findings widely
and improve awareness of the experiences of GP burnout.
Questionnaire
We would love to hear from you about
how you found reading these research
finding summaries paired with art.
To complete the short feedback questionnaire either click on the
below link or copy and paste the address into your web browser:
https://westminsterpsych.az1.qualtrics.com/jfe/form/SV_23uuVTS7QOrPFEF
Overall, this study gave insight into the complexity and long-lasting
nature of burnout, highlighting the challenges burnout poses to
resilience and identity.
Participants tied their experience to the organisation they work for,
and most linked their experience of burnout to the medical culture
and the growing pressures around their role. We also found GPs
had inner conflicts, related to their work-life balance and the need to
prioritise their own health when faced with needing to take time off
or seek help.
We are currently working on the second study of this project -
exploring GPs' stories of recovery from burnout through interviews
and photographs.
Thank-you
Thank you for taking the time to read the summarised research
findings. We would also like to thank the GPs who generously shared
their time and experiences for the purposes of this study.
Study Conclusions
We Want to Hear Your Views
Contact
To contact the research team, please email Pippa using
P.Shaw@my.westminster.ac.uk
If you are a GP and would like support with burnout, please contact
the Practitioner Health Service. Details can be found via
practitionerhealth.nhs.uk or by calling 0300 0303 300
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ResearchGate has not been able to resolve any references for this publication.