Wellbeing advice for new GP trainees

By Dr Ginita Oberoi

A wide array of experiences may lead to a doctor choosing general practice training.

Some doctors, knowing that they want to do general practice even in medical school, might join the program as an intern. Others might take a winding route through other training programs, working overseas or starting a family.

One thing that’s certain is that when considering the wellbeing of a GP registrar, there is never a one-size-fits-all approach.

Bearing that in mind, Registrar Liaison Officers (RLOs) like myself will often encounter registrars with the same barriers to wellbeing, especially during the first few months of training.

Most doctors, when starting out as GP registrars, would have had the majority of their medical experience in a hospital. The structured days and hierarchical teams of the hospital wards can provide a stark contrast to the relative flexibility of general practice, and can come as a shock to the system for new GP registrars.

Each of us eventually will find our flow and structure, but those first few weeks are hard.

There are some important questions to ask in the first few days at your new practice: ‘when should I check my results?’ ‘what should I be asking my supervisor to review?’ ‘what jobs can I give the reception staff and nurses?’ and ‘how do I manage abnormal results?’ are a few of these.

A lot of general practice is about managing time and information, and discussing practice management at an early stage can save a new registrar a lot of stress.

Another side effect of the transition from inpatient to community-based medicine is something I call ‘medical-admission-workup syndrome’, also known as ‘I need to do everything today’ disease.

Doctors in the habit of doing detailed inpatient admissions can find the paradigm change to general practice difficult.

The lesson is to remember that the patient can come back tomorrow. Remember to safety-net today and then review tomorrow. Staggering your work over several consultations can help you keep to time today.

The difficulty with this approach, however, is something that is part and parcel of general practice – dealing with uncertainty.

Many registrars struggle with the ‘what if ’s’ of general practice, worrying that they could have missed something. Doctors are a breed that usually like control and concrete solutions, but in general practice there isn’t always a concrete solution to be found!

There are two approaches to dealing with uncertainty that I have found useful, and they can be summed up in the mantra ‘minimise stress in and maximise stress out’.

What does this mean?

Well, for the first part, ‘minimise stress in’ is having structures and habits in place that give you as much control and closure on your day as possible.

This could mean taking 30 minutes to review your notes at the end of the day. If there is something that you notice on that review that you didn’t think of during the consultation, make a note and come back to it tomorrow.

You can also utilise the to-do lists and action lists of your practice software. If a clinical question is bothering you, add it to your to-do list or make an action in the patient file to review the patient in the future. Set aside a regular and specific time to review these lists and tasks so that they aren’t looming over your mind or constantly playing in your short term memory.

‘Maximising stress out’ is all about that elusive thing we like to call ‘relaxation’.

It’s a different thing for different people. For me, the word relaxation conjures up pictures of clay face masks and cucumber eye patches.

Unfortunately, most people don’t have a day spa at their daily disposal, so be practical about relaxation – indulge in the things that give you joy on a daily basis. It really is as simple as that!

You can also try some of these psychological doctor’s bag remedies to manage stress and anxiety.

Set aside ‘worry time’. This is a designated and specific part of the day when you can worry all you want. Take it one step further by writing down your worries and then recording the outcomes – did your worries come true?

Exercises like this can help you identify patterns like catastrophisation and can help focus that nervous energy and stop it from affecting you all the time.

If you find yourself worrying – save it for your worry time! There’s even an app for it called ReachOut WorryTime.

You can combine worry time with another helpful approach called Structured Problem Solving (SPS).

Here you write down what’s on your mind, and all approaches and actions you could take, from the silliest to the most sincere options.

Once you’ve written down all of the actions you pick one, commit to it and plan how you will
carry it out. A good model for SPS can be found at thiswayup.org.au.

Be kind to yourself

Often in our job, we can be kind to others and so harsh on ourselves.

When we have a patient who quits smoking or loses weight, we are full of praise and admiration.

Yet when we get praise or encouragement from our coworkers or patient it’s in one ear and out the other. We focus on all of our failings and ignore the small victories.

Whenever a patient would thank me for anything, I used to feel like a fraud. Negative thoughts would chase each other around in my mind: ‘they don’t know about all the things I’ve done badly, or how inexperienced I am, and if they did no one would thank me’.

The best term I’ve come across for this is imposter syndrome. But a GP registrar isn’t an imposter. Be kind to yourselves and treat yourself as what you are – a valuable, skilled doctor.

But more than that, we are not just doctors – GPs are people too and we have health needs. Have your own GP; preferably someone you don’t work with, and who you can trust. If stress, anxiety, depression or any other mental health problem is causing you distress, reach out and seek help.

There is a team of people out there dedicated to helping those of us who need it. Yes, even us GPs!

By Dr Ginita Oberoi, Registrar Liaison Officer with General Practice Training Tasmania.