How to stop worrying about patients as a GP

My only qualification to write this article is I’m a GP that worries a lot…

Last week I was worrying about a patient I had seen earlier.  “I should have done some observations,” I thought, lying on the sofa at home.  “What if they were actually really sick?”

In terms of the CBT principles, observations are GOOD because they are based in FACT (not feelings) but of course I was simply exhibiting negative predictive thinking (BAD) because the patient actually looked fine.  Observations were really only going to cover myself medicolegally and were in that scenario, what psychologists call Safety-Seeking Behaviour (BAD).  (Ok, ok, I know there are other reasons to do them).

Being a locum added to the problem as I couldn’t check up on them (safety-seeking again – BAD) so I got more worried and then, and, oh sod it, I’ll have glass of wine (Unhelpful Coping Mechanism – BAD) and so you can see how the whole thing goes on.

Nevertheless, I managed to rescue my overthinking brain. Over the years, I’ve developed a small army of strategies that helps me stay (mostly) on top of worry.  I can even enjoy working in that spine-chilling setting, Out of Hours.

None of them are a forever-fix – it’s a life long journey.  Let’s start with…

Limit Safety Seeking Behaviour

Medics tend to be obsessional types.  Being meticulous serves us well when the stakes of a mistake can be high.  Our training channels us into catastrophic thinking – always looking for the worst.  But the reality is we need to draw the line somewhere and the worst doesn’t always happen.

In CBT, psychologists encourage the anxious to experiment with not repeatedly checking up on things (so-called safety-seeking behaviour).  Patients in therapy try out the consequences and emotional reaction to not checking.  Checking actually reinforces the neural pathways of anxiety.

While the job does require checking and a phone call to a patient can be compassionate, if you’re frequently checking up on patients when you’ve left work, how much of this is about helping them and how much is really about you?

Thorough safety netting should enable patients to be responsible for themselves.

Move your body

It’s becoming a cliché now but exercise calms the mind.  You don’t have to be a gym freak (I gave up pretending I was one 10 years ago).  Do star jumps or arm lifts with a couple of books between patients (as recommended by someone on Resilient GP).

Turn off those negative thoughts!

Meditation is extremely effective at stemming intrusive flows of ‘what if’ worries about work.

Otherwise here’s a quick Mindfulness exercise: count 5 things around you that you can see, then 4 things you can touch or feel, 3 things you hear, 2 things you smell, 1 thing you taste and then pause.  Keep repeating throughout the day if necessary.

CBT

There is truly good evidence that CBT that using a book, a pen and paper and working on neutralising that ‘hot thought’ when the anxiety is in free fall, really can really re-wire those neural pathways that have gone way off course into all-or-nothing, catastrophic thinking.  You a have to spend a while kind picking a way at it but then the brain kind of resets itself.

Every GP knows online CBT websites but one less well known (and recommended as their go-to site by some brilliant therapist colleagues) is www.getselfhelp.co.uk.

Know your triggers

Tiredness is the most common one but it may be working in certain practices or dealing with particular conditions.  Fatigue can trigger behaviour such as rechecking things and even sending the odd patient going to A&E when perhaps you might have thought differently in the morning.

Learning to recognise it for what it is, can enable worries to just go with the anxious thoughts, go home and tell yourself it will all look better tomorrow.  Is it so bad to be anxious for a while if you know if will pass?

Do something that nourishes the soul

This doesn’t have to mean religion (although there is evidence that religious faith keeps people resilient).

Connecting with nature is a common example.   Greenery represents the cycle of life, death and renewal –  a reminder that ultimately, there are forces higher than the GMC…

I tell myself that maybe if I get struck off, I’ll launch a career as a gardener…another CBT point along the lines that, if the worst happens, I may have underestimated my resources to cope.

(Anyone need any deadheading doing in their garden?)

What resources do you use if you’re worried about work?

Claire Davies, GP and editor of the Network Locum (now Lantum) blog