Ordinary Superheroes

Last week the health of health workers came into focus. Simon Stevens announced a £5 million scheme to build the health of our 1.3 million NHS workers. From healthy eating to fast tracking mental health services this is an attempt to address a real problem.  The health of our GPs Something that many of us missed was that this includes a specific health initiative for GPs. The data around the health of GPs is contested - not least because of the immense difficulties and shame attached to GPs admitting that they can’t make it all better even for themselves. But we do know that GPs are increasingly vulnerable to burnout and depression - with particular groups such as trainee doctors and women GPs most vulnerable to suicide - and that this problem is likely to get worse as the demands placed on GP surgeries go up.The lack of visibility of this initiative indicates one of the problems we have in keeping our GPs healthy.  Culturally we find it very difficult to regard GPs as ordinary human beings preferring instead to see them as Superheroes who can singlehandedly save us from the catastrophes of the NHS.  Systemic problems for GPs The reality is that over the last 5 years the systemic changes affecting GPs have meant that only superheroes need apply. Seven day a week surgeries, the creation of CCGs and holding the financial responsibilities of a broken system. Front line managers unprepared and untrained to manage clinicians and GPs having to juggle financial and clinical demands all in a 5 minute consultation.As a society we have lazily allowed the job of a GP to become impossible by playing games with health targets provoking an often deeply cynical response by clinicians to attempts to build their collective ‘resilience’.   In a context where 74% of GPs said their workload was unmanageable there are going to be days when the suggestion that you might want to drop a few pounds and go to Zumba at the end of surgery might be met with something pretty hostile.  One of the reasons why this situation has come about is that the NHS is politically driven by a narcissistic model of healthcare. This is a model where patients become clients and clinicians play a ‘yes’/‘no’ game where the realities of limitation and loss are hidden under a culture of ‘choice’. This is a La-La Land where healthcare is as simple as popping into a 24/7 Tesco rather than the reality that every year NHS staff donate £1.5 billion of their working time for free because demand outweighs paid supply.  The flexible role of the doctorGPs hold a difficult position in society. We want them to be authoritative and have all the answers - a surgical model where doctor removes the tumour and cures the patient. But we also want them to do a more delicate job of work to heal our minds and bodies which are both always involved in the process of getting better. This is a delicate procedure requiring sensitivity, diplomacy and a big dose of humanity. It means that we need our GPs to be very much human beings.Not wishing to take on the projective identifications of an entire profession, there is something about GPs that makes them vulnerable to the societal attack that they are under. By nature of the training, it attracts people with massive superegos that bark demands for superhero acts. These people are familiar with making massive demands on themselves - an internal script of do-this-now-! rather than what-can-I-realistically-do-?. For many the medical training is an entry into the Cult of Perfection where such massively bright and capable people become highly vulnerable to fantasies of omnipotence. Add to that the years of working in climates where human error and fragility is not tolerated and you might need a God Complex just to get to Friday. As a result, its possible that many GPs may not always be in a great position to assess their own mental health. It’s also the case that in order to survive work GPs need defences. As a GP you have to put on a psychic white robe and adopt a position where in the interests of the patient you have to do stuff that they don't want you to do. Putting it bluntly, a lot of medical treatment hurts and involves getting patients to do things they don't want to do. From heart medication to losing weight the Doctor sometimes has to know best and have the authority to defend that position with the patient.   At the same time a doctor cannot always be so defended that they are unable to respond to the patient with some degree of curiosity and compassion. By being cut off from patients the real problems can get missed. This is particularly the case with mental health where the psychosomatic complaints we innocently take to our GPs are sometimes code for distress. It takes a real human being to spot the human in others so GPs have to be defended enough to treat the patient even when it hurts but not allow those defences to become so brittle that they cease to care.   It means that the optimum situation is that GPs can shift their roles and ways of working within every working day, even within each consultation. Robust enough to treat a patient that doesn't want to hear it and emotionally engaged enough to actually listen to the patient who doesn't know what’s wrong.  How doctors treat other doctors In an interview last week I did about the working lives of GPs I had the huge pleasure of talking to Clare Gerada, who is a GP and works with the NHS Practitioner Health Programme and Chris Manning from Action for NHS Wellbeing, a network that works for a healthy workforce. These people are of the brave and humane variety. Willing to talk about their own states of mind and at the same time possessing the brass to shout loud at policy and committee meetings where talking about depression and burnout is received like a fart in a lift. Both organisations offer support to individuals but more importantly they offer an invitation to GPs to form relationships with each other where the reality of their situations can be known without shame. The increasing uptake of these two networks remind us of the possibility that GPs can operate on these different levels but in order to do this requires more than just helping individual GPs and also requires a coordinated and collective response. The existence of GP networks, whether its at the level of new GP Federations, the BMA or support groups like these - is not just of therapeutic importance, its also of political importance. Because until GPs can openly challenge this system of impossible targets, they cannot establish a profession worthy of them. This means moving beyond the individual towards developing relationships with the people we work with that are sufficiently strong to challenge the demands being placed on us.The new occupational health scheme is a possible opportunity for GPs but as the crisis deepens, how doctors treat other doctors matters more.   From October 2015 we will be running courses at the Tavistock Clinic in London - Guardian's Short Course and Surviving Work: How to manage working in health and social care. This blog was produced for theconversation.com for our column Battles on the NHS frontline: Stories from the vanguard of health and social care. Please help us build up a picture of what is happening in health and social care by sending us your Stories from the Frontline here.