Editorial

This month’s article from Grace Castronov on the doctor wellbeing toolkit chimes with the oft-described worldwide public health crisis: Physician burnout. It gives excellent advice and raises a few questions. How well are we looking after ourselves? Who else looks after doctors’ wellbeing? How well can we care for patients if nobody cares for us?

Many of you are just embarking on careers, learning about general practice, considering where you might fit in, but also how work might fit into a good and balanced life, whatever that might be! Is now a good time to look ahead and consider a truly person-centred approach to holistic healthcare, one that permeates every level of healthcare and considers patients, individual doctors, the team, the organisation and the country as a whole? Caroline Elton, a freelance psychologist, considers that we and the NHS need such a holistic approach and that we might have something to learn from contemporary approaches to another public health problem, infection control, when considering physician burnout (Elton, 2019). She reminds us that measures to improve wellbeing often concentrate on individuals, even though research highlights the organisational origins of physician burnout. In the United States some health institutions are appointing chief wellness officers to help reduce physician burnout.

What does this mean for UK general practice and the NHS? Caroline Elton cites examples of an erosion of informal, supportive structures within training (the doctor’s mess, the old style ‘firm’, smaller medical schools) and some less supportive trends (short rotations and doctors living off-site in unfamiliar cities). All unintended consequences of well-intentioned change. We may be able to answer some of these questions by enabling supportive measures at the individual and practice level. We may do so by initiating efforts within new and emerging organisational structures. Dare I say, within primary care networks? But be careful. Let’s not make things worse, unintentionally damaging what works while trying to solve some problems.

So, while wellbeing can be addressed at the individual level, we must not neglect other causes of burnout within our practices and more widely that erode patient and doctor satisfaction. For example, we might choose to better protect what lies at the heart of an important, satisfying job: The traditional consultation. We might choose to stand up for a greater good and resist the unintended consequences of simplistic solutions to lack of capacity in general practice cited by Roger Neighbour (Neighbour, 2019). Does less continuity of care erode patient satisfaction (‘Why don’t people love us like they used to?’) and the wellbeing of doctors? And what is more, do better consultations help prevent physician burnout? I suggest they do, in many ways.

The majority of patients with advanced incurable disease are cared for by their families and by GPs. Palliative care, like much of our work, needs a holistic approach with effective communication, advanced care planning and respect for patient autonomy.

This month we feature two excellent articles that consider aspects of palliative care in this context. Amarjodh Landa considers fatigue and lethargy and Monica Kumar looks at the management of gastrointestinal symptoms.

Many of us will learn everything we know about many subjects from a GP perspective, when the knowledge and skills overlap with another specialty. Two very helpful articles on common ENT problems, otorrhoea by Mark Newton and Paraskevi Tsirevelou and blocked ears by Oliver Wright et al., describe conditions mostly managed in primary care. These articles exemplify the need to manage patients with common ailments with the ability to recognise when referral to secondary care, occasionally with some urgency, is necessary.

It can be a diagnostic challenge to identify patients with cardiomyopathy. Gregor Moncrieff et al. provide a detailed review to assist diagnosis and timely referral, but also to inform the longer-term management of patients and their families affected by cardiomyopathy. And what of the consultation, so central to our work? Dan Turley and Neil Metcalf consider some ethical challenges to make us think.

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