The importance of self care for GPs: tackling burnout through comedy

Ahmed Z Kazmi is a doctor and stand-up comedian. If you would like to see his show ‘Doctor in the House’ he will be performing at Brighton Fringe 20-24th May 2016, Hollywood Fringe 19th-26th June 2016 and Edinburgh Fringe Festival 4-14th August 2016. For lots more information and to purchase tickets please go to www.doctorahmed.net

At my medical school interview I was asked what I did to relax, I remember thinking that was an odd question. My GP training curriculum included lectures entitled ‘How to avoid burn out’ and I remember sighing and rolling my eyes. It was not until I was in the role of qualified GP for some time that I started to feel a drain on my wellbeing. Then in 2015 my father died from cancer and I really struggled to remain the empathetic and attentive doctor I had prided myself on being. The presence of grief and mourning added an additional ball to the juggling act of clinical duties, professional development tasks, administrative tasks, family and friend obligations and the banal tasks of daily living, and I found myself struggling. I suddenly saw the relevance of the question asked of me at my medical school interview and the rationale for the lecture on burn.

I think it is fair to say general practice is a high intensity occupation. The high volume of patient contacts per day plus the short consultation duration coupled with often unrealistic patient expectations create a sense of panic and unrest during the working day. The relatively frequent rearrangement of service structure and health policy combined with a constant media flurry around the NHS and general practice can produce for many GPs a gloomy atmosphere within which to work. This environment was sadly a contributing factor in my decision to move from the UK in 2014 and practice in Australia.

As mentioned earlier, it was not until last year that the importance of non-academic outlets and self care became evident to me. I used to consider exams or diplomas or courses a leisurely parallel to my role as a GP. I loved to learn, enjoyed keeping up to date and saw an update course as a luxury activity. With social media being inundated constantly with healthcare politics I found myself almost totally unable to switch off from the job, even in my personal time,  and for the first time decided to temporarily reduce my working hours and take up a hobby unrelated to my vocation. But alas the apple never falls far from the tree. I decided to try my hand at stand up comedy (not after an unsuccessful attempts at becoming a pole dancer and instagrammer respectively) and quickly had to embrace that my work as a GP was in fact my largest source humour. I decided to make a stand up show about the funny side of being a doctor. I wished to create something that would be playful and entertaining whilst remaining respectful to patients and the profession. I took a few months to write and rehearse the cabaret comedy show ‘Doctor in the House; What your doctor really thinks’ and made my comedy debut at the Perth Fringe Festival in February 2016. All my shows sold out and I received positive reviews from critics, colleagues and spectators. I managed to raise over $5000 AUS for a local cancer charity from ticket sales and donations. In addition to this I used the show as a vehicle for some more serious subtexts including patient responsibility, cancer awareness and bereavement. Above all the experience did renew my empathy and interest in my vocation.

The experience taught me that even in this current climate we can create opportunities for fun and laughter around our work. It is all too easy to become stationary in a vehicle stuck in mud where the wheels are turning but the car is not moving forward. Several of my friends had hobbies during medical school: music, art, fitness but sadly these were made redundant as general practice and family pressures grew. I would encourage the reader to gently reflect on the following questions:

1. Do you feel content at work?
2. Do you feel you are nearing burn out?
3. If you are content, well done, how can you ensure that continues? If not how might you address it?
4. Think of one or two hobbies/interests/activities (big or small!) you would like to do more of or have never tried and would like to sample.
5. Lastly think about how you might actually start to undertake the activity and create room for it in your life.

I am not suggesting everyone take a four month sabbatical and go on a world fringe festival tour of their solo stand-up comedy show… But I think now more than ever it is imperative for GPs to become good at self-care. Yoga? Swimming? Mindfulness meditations? Reduction in sessions? Cookery class? Or, yes, even stand-up comedy. What would you say to your patient in a similar position, need I say more!