Emotionally demanding workload and confrontational patients key stressors for GPs

January 12, 2018, British Medical Journal
Credit: CC0 Public Domain

The emotional impact of their daily workload and confrontational patients are among the key stressors for family doctors in England, reveals an analysis of feedback from general practitioners (GPs), published in the online journal BMJ Open.

Dysfunctional working relationships and unsupportive/bullying colleagues, combined with the fear of making mistakes, complaints, and inspections, add to the mix.

All this suggests that rising workload and long working hours form only part of the high levels of workplace stress and burnout widely reported among GPs, say the study authors.

They base their findings on in-depth interviews with 47 GPs to gauge their wellbeing and how well they cope with workplace stressors.

The interviewees were either depressed/anxious and/or suffering burnout, or returning to work after treatment for , or off sick or retired due to illness, or had no mental health issues. Over half were women (33).

Three main themes emerged from the analysis of the interview content: the of the work itself; practice culture; and work role.

The first of these refers to GPs' response to patients' suffering and the consequences of societal issues over which they had no control, as well as dealing with very demanding or confrontational patients.

Practice culture refers to practice dynamics, internal politics, bullying, and unsupportive mentors/supervisors/colleagues, while work role includes fear of making mistakes, facing complaints, the demands of revalidation, appraisal, and inspections, and financial worries.

These factors prompted GPs to express how isolated they felt, a sentiment expressed by most of the interviewees. This sense of isolation was made worse by an escalating workload, leaving them with less time to take a break or talk to colleagues.

And those with current or recent mental health issues frequently complained about the lack of support or acknowledgement of their condition from other colleagues and/or GP partners.

Significantly, those who said their colleagues were more supportive, responsive, and willing to talk about vulnerability and illness, felt less isolated, more resilient, and better able to cope with the emotional and clinical demands of their work.

Many of the reported stressors were interlinked and cumulatively contributed to, or worsened, existing distress, the comments showed.

"Providing a safe space for GPs to process the emotional and clinical content of their work and the potential stressors related to the organisational culture (eg bullying in the workplace) and relationships at work (eg collegial conflict) is imperative," emphasise the authors.

While GPs are expected to provide the space, opportunity and permission for their patients to voice their worries and concerns, "the same is not always offered to GPs," they note.

The ability to respond appropriately to patients' suffering without becoming overwhelmed should be taught in GP training as well as in ongoing supervision and support, they suggest.

"Tackling the culture of invulnerability early on in medical training is also key," they write, adding that "talking, sharing and having one's feelings normalised, understood, and validated are critical in maintaining good mental health."

And they point out: "This study highlights that the sources of stress and distress cannot solely be attributed to increases in workload and occupational stress linked to the work role demands of being a GP."

Explore further: New research reveals workplace bullying and violence are risk factors for type 2 diabetes

More information: Ruth Riley et al. What are the sources of stress and distress for general practitioners working in England? A qualitative study, BMJ Open (2018). DOI: 10.1136/bmjopen-2017-017361

Related Stories

New research reveals workplace bullying and violence are risk factors for type 2 diabetes

November 13, 2017
Workplace bullying and violence may increase the risk of type 2 diabetes, for both men and women, according to new research published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]).

More support needed for nurses facing mistreatment at work

October 19, 2016
New research suggests that nurses need more help dealing with disrespectful behaviour from colleagues if patient care is to be maintained.

One in five UK NHS staff report bullying by colleagues

July 1, 2013
One in five UK NHS staff report bullying by colleagues, with almost half saying they have witnessed bullying, in the past six months, indicates research published in the online journal BMJ Open.

Sick doctors returning to work struggle with feelings of shame and failure

October 15, 2012
Doctors who have been on long term sick leave find it hard to return to work because they are overwhelmed with feelings of shame and failure, and fear the disapproval of colleagues, finds research published in the online ...

Health service complaints system risking patients' and doctors' health

November 22, 2017
The General Medical Council (GMC) regulates doctors in the UK and can stop or limit their rights to practice. Around 9000 doctors a year are reported to the GMC, and around 160 are suspended or erased from the medical register.

Recommended for you

Research reveals stronger people have healthier brains

April 19, 2018
A study of nearly half a million people has revealed that muscular strength, measured by handgrip, is an indication of how healthy our brains are.

Overcoming bias about music takes work

April 18, 2018
Expectations and biases play a large role in our experiences. This has been demonstrated in studies involving art, wine and even soda. In 2007, Joshua Bell, an internationally acclaimed musician, illustrated the role context ...

Study suggests we can recognize speakers only from how faces move when talking

April 18, 2018
Results of a new study by cognitive psychologist and speech scientist Alexandra Jesse and her linguistics undergraduate student Michael Bartoli at the University of Massachusetts Amherst should help to settle a long-standing ...

Scientists disconfirm belief that humans' physiological reaction to emotions are uniform

April 18, 2018
How do you feel when you're angry? Tense? Jittery? Exhausted? Is it the same every time? Is it identical to how your best friend, co-worker, or barista feel when they experience anger? In all likelihood the answer is no, ...

How mental health diagnosis should be more collaborative

April 18, 2018
Mental health diagnosis should be a collaborative and useful process, not a meaningless label - according to new research from Norfolk and Suffolk NHS Foundation Trust (NSFT) and the University of East Anglia.

Does pot really dull a teen's brain?

April 18, 2018
Pot-smoking teens may not be dooming themselves to a destiny of dim-wittedness, a new review suggests.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.