Back from hols.

Just back from skiing holiday over Christmas. Lots of snow, blue skies, fresh air, exercise and relaxation. No TV or internet, and quality time with the family.

When I was a full time GP I took 8 weeks holiday a year, plus bank holidays and had a half day off a week with no nights or week-ends on call.

However, my first job as a surgical houseman was 108 hours a week with no days off and 2 weeks holiday each six months.

My early years in general practice we had eleven hour days, worked Saturday mornings and did a night and a week-end rota of 1 in 5. It was hard, yet rewarding. However looking back we all suffered various degrees of burnout, and in some instances depression and stress related illness. So I would not go back to those days.

As a holistic doctor I feel it is important to take time out to enjoy yourself and pursue other interests. And to have time for friends and family. But more importantly time for yourself-to relax and reflect -to have space to think, ponder and process feelings.

This needs planning. Book holidays and on days off do something you enjoy that is not work related. Also during your working day have breaks, even short ones. I play a short tracks from a CD on relaxation which is on my practice computer called Just-a-minute. These are one minute relaxation and meditation tracks. I find really helpful to keep up my energy and enthusiasm. You can download all 21 tracks for free.

Burnout in teachers

End of the school term just before Christmas- guarantees several teachers will make an appointment at the surgery. Common symptoms are excessive tiredness, poor sleep, general aches, and respiratory infections. In teachers hoarseness is a frequent feature. This is called laryngitis and the treatment is simple; rest, paracetamol and no talking-or singing for that matter in the school choir.

However it is worth enquiring a bit deeper as the symptoms may be a sign of stress.

Jane consulted me this week with hoarseness. She had been a primary school teacher for 10 years. Routine questioning confirmed a viral laryngitis. But when I added a simple additional question, ‘How are you coping?’ it resulted in floods of tears. The truth was she had not been coping for a long time. She was stressed and exhausted. She is worried about her job, is lacking in self confidence and sleeping poorly. When she started her job as a teacher she loved it. However recent changes has altered the job beyond recognition. There is more paperwork, target setting and expectations of her are much higher. Many children seemed out of control.

This made her angry, depressed, and frustrated all at the same time. But most of all she was mentally and physically exhausted and now did not really care anymore.

This sounded like burnout and it is quite common in the medical profession too.

So what advise to give her? She needs to begin first to care for herself. Do the things she enjoys doing, and do more of it- walking, meeting friends, listening to music, relaxing. The Christmas holdiday may not be long enough. She needs help and support at work and at home.

I have asked Jane to come back and see me before she goes back to school to discuss what else we can do, and decide if she is fit to return to work. It my experience she will need counselling, support and perhaps anti-depressants over the next few months. It would be sad to see her leave the teaching profession -I hope it does not come to that.

An article in the BMJ in November showed how counselling helped doctors with burnout.

Migraine headaches

Migraines can ruin your life. But Mary (not her real name) is determined the attacks will not ruin hers. She is thirty, has four children, works part time and migraines have plagued her for 12 years.

She had eliminated all the common trigger factors, such as cheese, chocolate and alcohol searched the internet for a remedy tied most of them but without lasting benefit.

She has been to the neurologist at the hospital. He was sympathetic and suggested several drugs but none suited her because of the side affects.

The last time I saw her I suggested she tried meditation and she said it certainly helped reduce the intensity of attacks. However they still affected her about eight days every month. Now she did admit she is a high achiever and tends to be obsessional- typical migraine sufferer personality traits. But it made her who she is-a successful mother and management consultant. Anyway personality can be difficult to change!

I suggested she might like to try cranio-sacral therapy. This is like gentle osteopathy to the head and spine with some hands on healing. If you follow this blog I will let you know how she gets on the next time she consults.

My First Blog

My daughter is training to be a journalist. She blogs. She says if you want to communicate to anyone under 30 years old you need to blog. Blogging is the verb. A blog is what you write.

I think the holistic approach to general practice is important. So I am going to write a blog on my experience as a general practitioner and how a holistic approach is practical and useful to patients and doctors.

She also says that blogs should have links to other sources. Not references as we use when writing an article for a journal. But something that you can click on and get instantly connected to.

Have you heard of the 5th Estate?
‘Witnessing the rapid rise of wikis, blogs, and many other online social networks (such as FaceBook, YouTube, and MySpace), we wonder if we are ready for what has been called the Fifth Estate,- a new form of civil society participation, enabled by the growing use of the Internet, mobile phones, and related information and communication technologies.'

This came from the BMJ 13th December 2008. ‘How should health be defined?' Vol 337 p1364. That is an old style reference. Clicking on the above will take you instantly there.

My blog will be mainly case histories and may include podcasts and other such new communication developments. I hope you will connect to my adventure.