Is loneliness the HPV of general practice’s burnout cancer?

Orla Whitehead is a GP, and researcher at Newcastle University. She researches Spiritual Health, GP Burnout, and the links between the two.

“These days, loneliness is the new cancer… A fearful, incurable thing, so horrifying that you dare not to mention it; other people don’t want to hear the word spoken aloud for fear that they too might be afflicted.”¹

As Gail Honeyman’s character observes in Eleanor Oliphant is Completely Fine, loneliness is a hidden, silent risk that affects doctors as well as patients.

At the 2025 World Organization of Family Doctors (WONCA) World conference in Lisbon, I attended lectures, seminars and workshops on GP burnout. In Andrée Rochfort’s workshop, I joined GPs from across the world who recognised GP burnout as a growing ‘cancer’ affecting the workforce in terms of attrition, patient safety, undermining developing effective and resilient primary care globally. We discussed practical changes that increase practitioner wellbeing- team breaks, easy access to the latest research and guidelines, contactable secondary care, peer support. Yet beneath all of these suggestions ran a common theme: a striving for connection. What people described, in essence, was a yearning to feel less alone.

No other specialty in medicine spends more time one on one with patients, without team input. Primary care is uniquely placed where one practitioner often meets in one room, with one patient, for merely a few minutes to attempt to make their lives better, and then move on. Some GPs can go days where their only interaction with others are people expecting them to solve a problem for them in some way- In my own qualitative research with UK GPs, an early sign of burnout was the loss of faith in primary care as a team endeavour.² Instead, an internal narrative begins of, “I’m the only one who can…” This mindset creates a negative cycle of isolation. The lone practitioner becomes truly alone.

The unifying theme of the suggested changes to increase wellbeing was that they relieved the loneliness of being a GP. If GP burnout is a cancer, then loneliness is the widespread, frequently ignored, pre-cancerous change- the HPV of burnout. Loneliness is dismissed, until the damage is done. The workshop group ignored the mention of the word loneliness, and quickly moved back to the practical, avoiding a deeper understanding of our human weaknesses. We cannot continue to ignore our own humanity and need for connection if we are to meet our patients’ needs safely. The Triple Aim -enhancing patient experience, improving population health, and reducing costs- is widely accepted as a compass to optimize health system performance. Bodenheimer and Sinsky recommend that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.³

If we are to address burnout in a meaningful way, we need to understand it better. As a profession, we need to understand that we are a vulnerable group to things like loneliness. If we shy away from looking at precursors to burnout such as systemic loneliness, we remain unable to find systemic answers to it. Until we name loneliness as the HPV of burnout, we will not be able to develop the systematic strategies needed to inoculate us against it, and address rising rates of the burnout cancer.

References

1. Honeyman G, Eleanor Oliphant is Completely Fine, HarperCollins, 2018, ISBN 9780008172145, paperback, 400 pages, £9.99
2. Whitehead, I. O., Moffatt, S., & Hanratty, B. (2024). ‘I just felt either I’m going to kill someone or I’m going to end up killing myself’. How does it feel to be burnt out as a practicing UK GP? European Journal of General Practice, 30(1). https://doi.org/10.1080/13814788.2024.2426981
3. Thomas Bodenheimer, Christine Sinsky (2014) From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider The Annals of Family Medicine 12 (6) 573-576; DOI: 10.1370/afm.1713

Featured Photo by Konstantin Dyadyun on Unsplash