Dr Ed Pooley, GP and communication expert, gives advice on approaching GP colleagues struggling with burnout or workload
Dear Dr Pooley
How do I approach a colleague who appears to be struggling with burnout or workload issues?
We’ve all been there. A colleague appears to be struggling, but they haven’t said anything outright. The end result of helping them is of course important. But actually getting to that stage and broaching the subject can sometimes feel easier said than done. You want to be able to offer support, but equally you don’t want to step on their toes, embarrass, or patronise them. This situation requires sensitivity and empathy if you are to reach a successful outcome.
The following points are important when considering your approach.
- Choose an appropriate time and place. Quiet areas are better as feedback is not generally successful as a group activity. Try and arrange a time when they do not have clinic commitments or are distracted.
- Use observation rather than judgement when framing your opening statements. For example: ‘I’ve noticed that you seem more tired than usual’ rather than: ‘You seem really burned out.’
- Respect their privacy and boundaries. Not everyone will feel comfortable opening up to colleagues and may feel threatened by the conversation. Acknowledging this dynamic can often help.
- Active listening and empathy will help: ‘I care about how you are doing and wanted to see if you are OK’ is a useful phrase that highlights your desire to support rather than criticise. Give your colleague space to talk about what they are experiencing, summarise where necessary to demonstrate that you are listening and engaged in the conversation.
- Broach issues that may need action. If your colleague’s behaviour is impacting on their ability to work effectively, this needs raising. As doctors we are typically resistant to being told that we are not managing effectively or that adverse clinical consequences are a possibility. Offer practical help. If your colleague is open to the option, offer solutions that you can offer or ways that the practice might help them navigate the issues they are experiencing.
- Agreement and follow-up. Agree a plan of action and arrange follow-up. If your colleague is unwilling or unable to acknowledge difficulty, it may be that they are feeling shame, guilt, or a fear of threat. Reassurance that acting now is less problematic than waiting for the situation to get worse may be needed.
These types of conversations are becoming more frequent as the stresses increase on individual GPs and on general practice as a whole. We are being asked to do a lot more with a lot less. Medics often have a belief that they must ‘be perfect’ or ‘push on’ even when they begin to struggle, which develops a vicious circle of burnout. It is crucial to have a conversation (rather than avoiding it) for several reasons.
- By acting early, you may prevent further decline. Burnout in healthcare workers develops insidiously and then escalates quickly; physical symptoms of exhaustion and mental health effects can lead to more challenging doctor-patient interactions, increased risk of complaints and expressed frustration and then more challenge. This can impact on colleagues and patients and start to negatively affect the whole system.
- Promoting a supportive work environment where opinions, feedback, and emotion are acknowledged and acted up tend to build team resilience, reduce stress among the workforce, and improve workforce loyalty.
- Acting when colleagues struggle reduces the stigma around mental health and normalise help-seeking where necessary and facilitates mental health discussions.
This situation encompasses the notion of a ‘stitch in time saves nine.’ But we must always be mindful of the duties required of us stipulated in Good Medical Practice. If your colleague is unwilling to have a conversation with you or another team member, and there is the potential for their well-being or behaviour to impact on patient care or team function, you may have to escalate your concern to the Local Medical Committee, NHS England or the GMC.
Of course, this is a final resort only to be used when necessary. In most cases, there should be an opportunity for informal intervention and conversation as outlined above, to help our colleagues when they need us most.
Yours in solidarity,
Ed
Dr Ed Pooley is a GP with expertise in time management, patient communication, and managing ‘difficult conversations’. He is the author of Managing Time in Medicine: Developing Efficient Consulting in Primary Care
