Burnout: ‘I didn’t want to talk to anyone’

As the crisis in general practice deepens, Dr Ed Schwarz writes about his experience of burnout and how he recovered from the work-related stress to reclaim his life and work

‘Daddy’s crying.’

It was in the middle of the pandemic, on our favourite beach in Cornwall. My wife was 28-weeks pregnant with our second child, and our two-year-old son had been happily playing in the rock pools. I say happily, but we had had the usual tantrums about getting him into a wetsuit, requiring hostage-style negotiation skills and ice-cream bribes. Still, life should have been perfect. 

‘He’s okay,’ my wife said to my son. ‘Let’s go home now.’ 

I sat in the car in silence, tears streaming down my face.

That day on the beach, I had reached my breaking point. It all started a few months before.

I was a new GP. I had gone straight from my registrar year into partnership at my practice. The former RCGP chair Dr Helen Stokes-Lampard had come to open our shiny new health centre, which was made up of three surgeries. She said, ‘You are only a retirement and an illness away from a struggling practice.’ We all laughed, pitying those poor practices. But just a few months later, my trainer – who later became my partner and friend – was diagnosed with cancer and needed time off for treatment. 

Shortly afterwards, another partner decided to retire. We were down to three partners, managing 7,000 patients. Locums were hard to come by, and those we recruited didn’t want to do visits. Then, another partner started showing signs of burnout. The pressure was piling up.

As a result, my 8-6 job became a 7-9. I was logging in on days off just to keep on top of the letters and tasks and pathology. Our computer system provider went bust, and we were told we needed to integrate EMIS into our practice. For a few weeks, everything went back to paper. One day, at the end of a long shift, we were literally surrounded by paper lab results, documents and letters. At this stage, I felt I was coping; this was just one of the ups and downs of partnership, right? I was managing, and I was fine.

But I wasn’t managing, and I wasn’t fine.

I would come home from work late, my son already asleep. My wife would always ask how my day was. ‘Fine,’ I would reply. I didn’t want to talk to her. I didn’t want to talk to anyone. I would just sit there reading the news, learning about the next Covid plan. My wife and I have been together for 13 years, and we have always shared everything. But I would grunt at her and kiss her good night perfunctorily.

I stopped exercising. There didn’t seem any time to go on a run any more. I was exhausted and couldn’t get up earlier to swim before work. I started eating more chocolate as a pick-me-up and my weight started increasing, which made my self-confidence go down. I was overweight, a shit GP, and a bad husband and father.

I withdrew from my social circles. I have always loved having a group of people around me, and I stay in touch with my friends. But the idea of picking up the phone to speak to one of them filled me with dread. I became jealous of other people, believing their lives to be perfect. 

I have always slept well. But I would wake up in the night, imagining consultations I had done, worrying about what would happen if I made a mistake and lost my job. I started sleeping downstairs to try and not disturb my wife.

I have always prided myself on being approachable and someone people could turn to, but my ‘empathy bucket’ wasn’t just empty, it had a hole in it. My ‘open-door policy’ became closed. Patients, angry due to delays in accessing healthcare, hurt me again and again. My colleague who was on the verge of burnout should have had more support from me, but I couldn’t offer it. I was just about managing, so why couldn’t they? Then, when they inevitably went off sick with stress, the workload increased for those of us who were left behind, and I felt angry. Rather than trying to acknowledge that this was an issue and we were taking heavy casualties, we just dug our trenches deeper and settled in for the long haul.

To rub salt into the wound, I received a complaint from a patient. It was vindictive, personal, and later turned out to be completely unfounded. But at the time, it felt like an attack on my whole sense of worth. Most patient complaints are usually due to communication issues, and there were good lessons to take away from this particular one. However, by this point, I was ready to quit general practice.

So, what changed?

Well, that day on the beach, I cried involuntarily. It should have been a moment of joy shared with my beautiful family. I cried because I wasn’t enjoying it, but knew I should have been. I didn’t see a way out.

Later that day, my wife and I drove to the cliffs and spoke for the first time in months. She had my back, and together we made a plan. I had a mentor from the new-to-practice fellowship who picked me up and helped me through the grieving process of being the GP I wanted to be. As partners, we met up and made a plan to work smarter, not harder, with systems in place. We did a recruitment drive and now are ‘over doctored’, which has resulted in a better work-life balance for everyone. 

I stopped having emails on my phone, reduced my screen time and took regular leave. I now recognise when my letters to consultants become more rude or sarcastic and that it is a reflection of the pressures I am under. Likewise, when people are rude to me, they are probably stressed, angry or afraid.

I also pursued my dream and started working as a training programme developer. It is an outlet for creativity through which I hope to inspire the doctors of tomorrow to love general practice and keep the ideals of patient-focused community care.

Outside of work, I stopped drinking, ate healthier and started swimming in the sea before work with one of the partners. I learned to say no. Saying no is something we aren’t taught as trainees, but it is vital that we master it appropriately. Now, I run everything by head office (read: my wife) before saying yes. 

Thankfully, I have healed and come out the other side. The NHS Titanic is unsalvageable, but from the wreckage we still need crew in whatever the future system will look like. That’s why I hope my story can reach just one person and help them reach out for help from friends, colleagues and professionals. 

Dr Ed Schwarz is a GP partner and training programme developer in Cornwall