Dr Rupy: Today I'm talking to Professor Dame Clare Gerada about enabling our doctors and nurses to flourish and how to reignite the passion and bring the joy back into medicine. I learnt so much about Clare today, her background living in Africa, her dad's medical career and how she keeps going working in the same practice for decades, as well as her brave admission of how burnout affected her personally. Professor Dame Clare Gerada has more than 35 years experience practicing medicine and has been a driving force behind efforts to provide more wellbeing support for NHS staff, as well as being the first female chair of the Royal College of General Practitioners, the RCGP, in 50 years. Clare has held leadership roles within the Department of Health and is on the council of the British Medical Association. Our chat today, which you can also see on YouTube, just go to the Doctor's Kitchen YouTube channel, covers what's not working within the current system of care and how we rectify it, open science and the pandemic, the constant blaming of GPs, over-medicalisation, and also how uncaring the system is actually towards medical staff. We also talk about some tips to maintain joy and optimism within medicine itself. Her book is Beneath the White Coat and remember you can find all this and more on the show notes page at thedoctorskitchen.com where you can also download the Doctor's Kitchen app for free to get access to hundreds of recipes, all tailored towards health needs and goals with new recipes added every single month. Android users, I'm working very hard on that, so look out for an Android version at some point later on this year. You can check it out with a 14-day free trial as well. And also make sure you subscribe to my newsletter, the Eat, Listen, Read newsletter. Every single week I send you something to eat, something to listen to, something to read, something to watch and a little funny joke at the end of the newsletter. People have said it is a joy to read, they look forward to it every single week and I love writing it as well. It's awesome. For now, here is my conversation with the wonderful Professor Dame Clare Gerada. Clare, thank you so much.
Professor Dame Clare Gerada: Thank you.
Dr Rupy: For taking the time. Honestly, I'm such a privilege to to get to chat to you. I remember getting your emails from the college email every week and, you're just great. You're you're great.
Professor Dame Clare Gerada: The pleasure is two ways. It's so lovely to see you and all the fabulous work you're doing. And I'm proud that you're a GP. It makes me feel so proud. So thank you.
Dr Rupy: Thank you so much. That's so lovely to hear. I think we can end the podcast there. No, I look, you you wrote an article recently in the Guardian. I just want to read this out. On the 18th of February 1992, I started at my GP practice. 30 years later, I'm still there, same room, same some same staff and patients. So much has changed but fundamentally the need for a GP providing personalised care remains. We must truly, truly must protect this. We're here today at the conference, integrating personalised medicine. Tell me about your GP journey and what we need to protect and what's changed to the point where you wrote this really emotive article. I'd really love to dive a bit deeper into it.
Professor Dame Clare Gerada: Yeah, of course. You've got to understand my background. So I came to this country as a five-year-old from Nigeria, actually. My father, I'm a double immigrant. My father, parents moved to Nigeria soon after they married and then they emigrated to this country. And he was a single-handed GP who started out his practice in the front room of our house. So my earliest memories are appearing over the balcony of our home, looking at these women mainly, carrying their small children and my father basically being this family doctor. And though he moved the practice down the road, I was still brought up with this idea that he was the family doctor. And for years, patients would wander in and out of our home. I would answer the phone, hello, this is Peterborough 54885, Dr Gerada's daughter, how can I help you? He used to take me on home visits when I was quite young, nine or 10, and he used to talk to me about what made a good GP, which was being there, basically being a good communicator and actually being part of one's community. And I absorbed those messages and though I don't work in the same way, I became the family doctor to my parish in Southeast London and tried and really tried to model my behaviour on what dad did. Now, the system around us has made it very difficult for that to continue. Number one, it's very hard for people to live in their parish, certainly in London. The second is that the intensity of the workload, the shortage of GPs, the focus on the industrialisation of medicine has meant that that personalised care, that continuity of care across the ages is the thing that we've sacrificed. And I think really and truly to our detriment because the unique selling point of a GP is the ability to care for their patients in the context not just of their disease, but their disease across their lifespan. And I'm not looking back with rose-coloured spectacles. I'm just saying what works and what works is continuity of care. It saves money, it saves time, it stops medicalisation, it stops medical errors. And who delivers continuity? GPs. What haven't we got? Is we're about 20,000 GPs short in this country, is GPs and what can't we provide is continuity of care. So that's what that article was really about.
Dr Rupy: And how, this is a very difficult question obviously, but how do we rectify that? I mean, aside from attracting more people into the profession at large and then training them into general practice and giving them that that sort of ideal of what a GP should be there to provide continuity of care. It's very difficult in the current context where people are struggling to get that continuity. They're trying to see their GP. We hear this echoed everywhere.
Professor Dame Clare Gerada: It is, well, it is sortable, but we we're working on against the forces of the media. So for example, digital. Digital triage will help because digital will allow us to put the right patient into the right place requiring the right amount of time with the right amount of urgency. And we're already doing that. During the pandemic, we had a thousand percent increase in digital consultations. So we can already start to do that. We can start to use the skill mix despite the negativity around employing others. Actually it's really good news that we can employ very highly trained physician associates, highly trained pharmacists. So we can start to move the patients into the right space. We can also, what is already happening, is we're working together better in teams. We call it primary care networks, it doesn't matter what we call it, we're beginning to to move the sort of acute patients. So really, if your child is sick, you want to see the first person that's available. If you want to discuss your infertility, you want to see a doctor you know and trust, even if it's for episodic continuity, you want to do that. So already we can do that. We need to, I do, I am optimistic with integrated care systems, but where I'm not optimistic is the constant blaming of GPs. We're sitting at a conference now, we heard it again today on over-medicalisation, multiple prescriptions. Well, there isn't a GP in the land that really is desperate to cut the number of prescriptions their patients receive. Yet we're forced to do it. We're forced to do it by the regulators, the inspectors, the secondary care practitioners. But the speaker on the platform today basically blamed primary care without actually blaming the system. So I think we've got to change the narrative. I think we've got to call out the anti-GP, a bit like we call out racism, a bit like we call out sexism, we have to call it out every time we are blamed personally and professionally for a system that is way out of our control.
Dr Rupy: And I hear that echoed a lot with particularly my junior colleagues. I've had a relatively short clinical career, coming up to about 15 years now.
Professor Dame Clare Gerada: Don't look old enough to have 15 years.
Dr Rupy: It's testament to what I preach, the nutrition and the lifestyle element and all the rest of it. Tell me some of your magic. Um, but a lot of my, a lot of my colleagues of my sort of generation are really getting beat down. I agree, it's partly the media. I agree it's partly because of the the inefficiencies in the systems that we have. How do we reignite that passion for being that continuity of care? We we spoke with Lord Nigel Crisp earlier about this and he was saying there's a lot that we can learn from developing countries and how actually putting more people within the communities and setting out health agendas in that respect could be interesting. But how do we get the passion back into the...
Professor Dame Clare Gerada: I think we learned from the pandemic. Would you imagine that you would have patients talking about immunosuppression, T-cells, RNA? Could you imagine? Let alone having a sensible conversation about the risks and benefits of a second or third vaccine, whether they should use a recombinant DNA one. I think we've got to learn from the pandemic. The pandemic allowed patients to do their own testing. I mean, I'm old enough when we weren't even allowing patients to do their own urine test. And and actually to start saying to our patients of which there are 50 odd million of them, your, you can do this. You can, you can sort it out. We can support you in that. So I think we can do things. But my other sense is we've got to bring the joy back into medicine. The the most fabulous, listen, there is nothing more wonderful than seeing a patient. I was in this conference and somebody came up to me at the end and basically said, you saved my friend's life. And I didn't know who his friend was. He did mention, I didn't recognise his friend's name. Isn't that wonderful? How often do you get that? Now, I don't save people's lives. Really, what I actually do is make them feel better than when they came in. And we do that 20, 30, 40 times a day. What a wonderful profession to be able to do that. So, but with your hospital colleagues, I think what the pandemic taught us was that allowing junior doctors or doctors in training to work at the top of their license, to feel empowered to make decisions, to stop being infantilized, made their mental health better. So if we can only stop the what, you know, row back to where we were in the pandemic and bring some of those systems in, I think we have a better system when we start allowing people to have more control over their professional lives.
Dr Rupy: Yeah, yeah. I want to dive into a bit more about your personal journey. Thank you so much for sharing the story of you appearing over and and going on visits with your father. I think that's really telling. Um, you wrote a book.
Professor Dame Clare Gerada: Yes.
Dr Rupy: Um, Beneath the White Coat. And uh, you talk, you open up quite a bit about your own challenges and experience with burnout. I wonder if we could touch on that.
Professor Dame Clare Gerada: Yeah, of course. Maybe people listening to this will resonate because I was 40, just over 40. I had two young children. Uh, so one was three and one was, they were about eight and 10, two boys. And I could see that this was essentially the last summer before they grew up. I mean, I know that they don't grow up, but do you know what I mean? This was the last summer when they were little children. And I realised I was spending no time with them. I was not getting bored at work. I actually had lost compassion. I'd lost the spark, the interest. And as a GP and as a doctor, you have to have an interest in your patient. You have to be, not put it on, it has to be inside you. And I realised I just didn't care. I just and that they were getting more of my time than my own children, that there was nothing I could do to help them. I couldn't repair their damaged past. I couldn't get them new housing. And I think in retrospect, I was probably depressed, but of course I didn't recognise that. And I just really, just I walked home one day and just thought, I can't do this anymore. I want to spend time with the boys. I want to have a summer that is is open. And I just couldn't, I couldn't be bothered. And I remember going for work the next day just crying and thinking, I just can't do this. And my partnership is a really lovely partnership. And I broached it with the practice manager, could I take a sabbatical? And she allowed me or they allowed me what was a four-month sabbatical, which I actually wrote another book then about substance misuse, but it meant I didn't have to see patients for four months and I could spend time with the children, write this book and reorganize how I did my life and I returned and it's never happened since. And so that very generous of them and in fact it was uh, you know, I was very lucky, but that time out just re-energized me, allowed me to set the compass and to do what I wanted to do. And again, this may resonate with some of the the women. I I went back to work with my first child when he was 20 weeks and my second child when he was six weeks. And I mourned the fact that I had had no space with them during their infancy. And though I didn't articulate it like that in my head, I think that's what I was mourning. And this was the last bit of their childhood that if I didn't do something about, I would have missed it forever. Now, in fact, you know, they're grown up lads, they're fabulous boys, but it was me that needed it.
Dr Rupy: Yeah, yeah. I'm so glad you opened up about that because your experience, I think is is is telling of a lot of other people's as well. And the fact that someone of your position, your standing, you know, everyone looks up at you as like, this is the the ideal of what we should be going towards. I know you might not think that, but a lot of a lot of us do for sure. You know, you're definitely a pinnacle and something to to aspire to. You sharing that vulnerability really gave people space to open up. And I think compassion fatigue is something that is really um, something we don't talk about enough. I've talked about it with another colleague of mine, another GP on the podcast, actually. Wonderful GP. Um, talks a lot about nutrition and health as well and is a full-time practitioner. I don't know how she does all the other stuff that she does as well. She's got two kids too. Um, but starting this conversation, I think is the the first bit. You were lucky enough, I think, to have a a leave for four months. How do we actually instill that into the system that's already overstretched and we're struggling to get 20,000 more just GPs, let alone other vacancies that need to be.
Professor Dame Clare Gerada: Yeah, I know. And I and I think what really is important that we have a fundamental paradigm shift into into work. And we need to allow flexible work. The reason why so many doctors leave to go and work as locums is they want the flexibility of locums. We have to make it as easy to have that flexibility in a substantive post as we do as a locum post. And that doesn't mean there's nobody there to cover Christmas, because actually when you're younger and you need the money, you'll work Christmas because you get paid more. You'll work, you know, not everybody wants to take the summer holidays off. I don't anymore. Thank God, I don't need to take August and half term off anymore. But I think we need to make it flexible. We need to make uh compulsory shift working something that goes out the window. People want to work shifts, they can compulsory nights, they can work nights. And we've got to realize that and dare I say it, that women on the whole are the carers of children and their elders. And we have needs that possibly, though some men do, most men don't. So we have to actually acknowledge the difference between men and women in terms of caring responsibilities. And whether what I was experiencing, even thinking about it now, was a yearning for motherhood, which in fact, I hadn't, I mean, clearly I've been a mother, but this yearning to be with them, which is was indescribable in terms of words at the time. I just knew I had to be with them. You can't, you can't put a, you know, mandatory on that. You can't say, well, there's when a woman has a yearning, you have to just acknowledge that that's what happens and that there needs to be allowed to be the flexibility to be able to do that. The same with men, of course, you know, they want time to be with their families or even just to be and just to to do nothing but just be with themselves. So I I trust actually the dare I say some of the politicians who are actually trying to address the work life balance. Jeremy Hunt for example is health select committee has taken a lot of evidence looking at the workforce and how we can improve the working lives of all NHS staff and care staff in order to to keep them there really.
Dr Rupy: My my experience of positive work life balance actually came when I went to Australia for a couple of years. I worked out there after I became a GP because I was facing burnout. I spent time in A&E and ITU and the number one thing that people loved about working in the system, it's got very different pressures, you know, it's looking after 25 million people across the same landmass as America. A lot of people don't realize that. So the footfall is a lot different, but the work life balance is the main reason why people loved working in Australia. And I think if we can mimic some of those practices within the NHS, we can make it a lot more inviting as a profession to stay in rather than, you know, just thinking about the vacancies and working people as hard as they can.
Professor Dame Clare Gerada: Yeah, I I think that's right. There was some trusts have started to look at you choose when you want to work and actually it's improved the rota, not made it worse. So I think this is the next era of of professional working is where we have much better working lives and much better choice about what we do. This idea, it doesn't happen to me, never happened to me, you can't even take your wedding day off. Come on. Common, common thing I've heard. People people would be flabbergasted to hear about that. I and it's true because I've met so unless they take gaps in working, gaps, so they they cannot take guarantee that they can take their wedding day off. And if you think about it, you tend to plan your wedding 18 months, two years ahead. So you you've just got to rely on the system to allow you to take your wedding day off. Isn't that ridiculous?
Dr Rupy: It's indicative of just how hard hard worked the staff are, you know.
Professor Dame Clare Gerada: And how uncaring the system is. For a caring profession. I mean, you know, I okay, I got married on January the 2nd, but I could have been on call on that day. Yeah, yeah. I was able to plan my wedding. Come on. Yeah, yeah. So, let alone when your nativity play might be or you've got to take your your mother to to see the specialist or you know, those are the sort of things that we need to be building in and accepting that this is the norm now, not the exception.
Dr Rupy: Yeah, yeah. I think mental health and uh coping with adversity again was something that is a positive that came out of the pandemic. I've never been asked so many times, you know, how I've been.
Professor Dame Clare Gerada: Yeah. I was in a shop yesterday. I had to buy a new computer and they saw my NHS badge. It was a it was a shop that gives you an NHS discount. And the the young lad started asking me about my work over the pandemic and thanking me. And I felt really teary. I I just thought and then I thanked him for keeping a shop open, you know, from when. It was hard though, but so many people ask us, less so now in general practice because we're suddenly become the big enemy again, but that will pass.
Dr Rupy: That's the media narrative at the moment.
Professor Dame Clare Gerada: We're so lazy. We're lazy because we work half time, which is 38 and a half hours a week. We're lazy because we're all women. Well, we happen to have the uteruses that carry the babies. And we're lazy because we're not in the consulting room, but we're all over the place.
Dr Rupy: Yeah, yeah. And going back to the sort of the the staffing and the rotas and all that kind of stuff, you know, it sounds nonsensical, but actually instigating a choose your own rota or a four-day work week or things that you you would look at and think instinctively, that's not going to work because we're understaffed. We need all this cover, we need night shifts, all the rest of it. It does work. Because when you don't work people to the with an inch of their life, they can actually afford to do other things and they're better when they're in work as well.
Professor Dame Clare Gerada: But going back to how we can do that is delivering continuity. Now I know you might think how can you deliver continuity if you're working part-time or four days a week, it's not really part-time. But you can if you create micro teams and if you use digital as the medium to do it. So if we allowed people, this is for general practice, allowed people the flexibility to look at how they can work, the ways they can work, and we engaged with patients and we engaged with the media so we can explain what we're doing, I think we can get the best of both worlds.
Dr Rupy: In a lot of cases, you mentioned earlier, uh, about when you were going through a burnout period and you probably felt at a loss when people would come to you with medical issues and they most certainly would have had symptoms related to a physical or mental ailment, but the root cause of which was due to their social situation, their finances, housing, all the things that we turns up on our on our doorstep as general practitioners. How do you see the future of that being ameliorated within our current system? And do you think there should be a dedicated role at every practice where that is the focus for not necessarily a doctor, but but another profession.
Professor Dame Clare Gerada: Yeah, again, you see, with the stripping away of all the supports within one's community, the last place that you can go is either your place of faith, if you have faith, or your GP practice. And of course, patients are angry with us because we're not there like we were. We're not there to sort out these existential issues, the housing issues, the fact that you're in a difficult relationship. We are there, but we're so busy doing a lot of the technical work that we're not as there as say we were before. But it also then begs the question as you've just asked, should we be there for that? We're the only GPs in the world that deal with everything, physical, psychological, social. And we're the only GPs in the world, even the Australian doctors that would deal with every bit of the human body. So most GPs won't do obstetrics, some won't do eyes. I think Australian GPs don't do eyes. Others won't do mental health. And we also have fewer GPs per head of population than anywhere in the developed world. So it's not surprising that we're failing to deliver and patients are angry with us. But it may be time for us to scale back and actually to say, look, we can't do it all. We really can't. And we we're trying our hardest to do it, but let's see who else can come in to help us. If you were to say to me what needs to happen in the future, we've built, we built the health system probably in medieval times after the great plague with hospitals and primary care. We need to break that down now, post-pandemic, second great plague. Let's start moving hospital doctors into the community. They'll have a much better, much, much better working life. Let's work, get them aligned with us, not telling us what to do, but working with us in integrated teams. Let's start creating services that that patients will have to go to hospital, but bridge that gap rather than at the front door of the hospital, it's a different team, it's a different team once they go into the bed. Let's start designing a health system fit for the 22nd, 21st century, which is what we did during the pandemic. Then I think patients' lives, staff's lives will be better, patients will see less fragmentation of their care, and we will actually end up having a cheaper health service. So if I was to give a plea at all, it's that every single hospital doctor needs to spend at least six months working in a community setting. And and we need to create these these transitional teams uh and also special teams for those really complex issues such as the very frail elderly or the very complex comorbidity.
Dr Rupy: We've talked a lot about uh some pretty heavy issues. What are you what are you positive about in the future?
Professor Dame Clare Gerada: I'm positive about a lot of things.
Dr Rupy: I'm sure you are because you're you're privy to, you know, the the juniors coming through the ranks as well as your colleagues.
Professor Dame Clare Gerada: I'm positive about this. And I've been working now 40 years. It it's easy to look back and think it was all perfect. It wasn't perfect 40 years ago. We never talked about mental illness. A doctor killed themselves in an on-call room. Nobody even talked about it, let alone thought about any of the issues. We I'm very positive. I'm very, very positive about I'm president of the Royal College now and one of the joys of being president is you get to do the new member ceremonies. And you should see these doctors. Many of them are coming from overseas just like my father. And the skills that these doctors are bringing into our workforce. It's not about us, you know, how can we support them? Of course we have need to support them, but how can we, how can they help us develop an NHS that's fit for purpose? How can we use their skills just like they used, we used my father's skills and his generation to create the next, the the next paradigm shift in healthcare. How can we use their incredible talents that they're bringing? And how can we thank them so much for choosing to come to the NHS rather than choosing to go to the states or Australia? So when I do these new member ceremonies, it is the most joyous time because I see that the future of certainly general practice is safe, but also I think the future of the health service because they're choosing us and they're bringing with them so many skills, talents, experience. So I'm optimistic about that. I'm also oddly enough optimistic because every national leader in the health system is promoting wellbeing of the workforce and putting staff certainly as close as they can to first, if not immediately second. And that's really important. 10 years ago, nobody was talking about this stuff. So I I'm very optimistic about the future. I think there's going to be, as always, lots of problems, financial problems. We're hitting financial issues for our patients. We have to preserve the NHS. People often think it costs a lot of money. Listen, it would be catastrophic if at this stage in our fiscal cycle, we lose a free at the point of contact health system. It would be catastrophic to all but a tiny minority of very wealthy people. So I am optimistic. I'm, you know, there's a lot of problems, but I'm optimistic about the future. I'm an optimistic sort of person.
Dr Rupy: Yeah, you seem like a true optimist, which is which is great. I was going to ask you actually about how how you maintain your optimism. I mean, it seems sounds like, you know, you've got many sources that you can look towards. But I think on a very personal level, what are your tips for, not necessarily other doctors who who listen to this podcast. Um, there are plenty of of other people in various walks of life and various professions, people have taken leave that would really benefit, I think, from learning a bit about some of your daily habits. You might not even be aware of them that you do to enhance your your positivity.
Professor Dame Clare Gerada: Was it Monty Python who who let always look on the bright side of things. Yes. What do I, what are my daily habits? Right. I wake up very early, but that's a remnant from when the children were little. So how early do you wake up? About six. So my father used to say that sleep is an imperfection of nature. So I wake up very early. Now that there's no children at home, just my husband and myself, my sadly my dog died recently. I get up, I play a hand of bridge online. So I'm trying to learn to play bridge. Yes, I'm trying to learn. That's so cool. I know. I play this this one online. I play anyway, I'm trying to get better. I've given myself two years to do it. But then I just do the usual things. What keeps me healthy, what keeps me healthy, I think is I do have a capacity to cut out anxiety. So I joked in the conference that I watch back-to-back come dine with me. I do, but I also watch back-to-back MasterChef and uh great British Bake Off. I have the capacity for just compartmentalizing things and I realized this as I've grown older that this is the ability that I have. I I also I used to run, I don't anymore because I did my knee in, but I I suspect that I also because I've worked so hard during my professional life, things become easier as you get older because you've you've been there, done it and it and you can do shortcuts and you have lots and lots and lots of networks. So friends, of course, and family keep you sane and keep you uh grounded. So those are the nothing magic, nothing magic. I certainly don't do triathlons or or swim Hampstead Ponds first thing in the morning. I try and eat healthily. I really do. I I probably like many doctors drink too much. I don't drink phenomenal amount, but I probably drink a glass of wine every day, which is probably not good for me. But I try and eat healthily. Uh the one advice I would give to people with children uh is and something my husband did very early on is we take we took our annual leave. And when we took it, we used to take it to places that you couldn't use Game Boys if the kids were were little then and mobile phones weren't as invasive, but we used to take them to places that we couldn't use them. So we actually did have time with the family where we played card games and you don't sound like a romantic family, but we just spent time together. So take your annual leave. And if you're spending more than three or four hours at work every day when you shouldn't be, just start to think what is that doing to your own mental health. I know we're all, we all self-sacrifice, but actually self-sacrifice is is okay in a crisis, but when it's every single day, just stop, think and just realize that though you might think you're invulnerable, you're not.
Dr Rupy: I I think those are great tips and I think they probably do so much more for your cognitive wellbeing than you you might even be might even realize. And and also, um, I think this whole concept of attention switching, particularly as GPs, not to say that other professions don't have the same thing with all the multiple distractions and constant email that we have to deal with. But as a GP, you're constantly context switching throughout the entire day from a patient who's got chest pain, someone who's got depression, someone who's coming in for their jabs, someone who's coming in for, you know, social issue, etc, etc. And actually, that cognitive fatigue that someone would experience from that constant switching from from one uh person to the next is a skill that we need to teach better and and further on that point, I think it needs a lot more attention because that that ability to exercise self-control and willpower and self-compassion is a very important skill set.
Professor Dame Clare Gerada: It is, but even even I, you know, when I've done 90 patients in a day, I feel sick and you feel this rise of hatred of of yourself and it it's a terrible emotion, really terrible emotion. And that's where I think a lot of doctors struggle because they might then go home and have too big a glass of gin and tonic or drive very quickly on the motorway because they're so adrenalized. Uh, and I think what you have to do is to make sure that you understand that emotion and that it isn't, many people in today's talk were talking about it, this is adrenalized sense which is harmful, is is we've got to make sure it doesn't happen repeatedly, that you cannot do that. We are human and and you and everybody will recognize that. It's not the fatigue that I used to do when we did 120 hours on call. It's a very, very, very different emotion. Though we used to get that as well if people if you're woken yet again in the night to see somebody with what sounded like a trivial issue, you'd get angry, but this is a very different emotion. So I think it's understanding it and I think it's also making sure that when you get to that point, because that's when the harm happens to you and to patients because that's the point that you might flip and be rude to a patient. That's the point that you might make an error, is we've got to protect our our staff so that they're not put in that position where they're risking their livelihood by basically being in that adrenalized state where
Dr Rupy: Have you ever had it where you really can't, you don't want another patient to come in?
Professor Dame Clare Gerada: 100%, multiple times in my career. Multiple times. You know, there's the classic situation where you're being bleeped over and over again to see patients when I when I used to work in hospitals. But then there's the the additional sort of uh added stresses of the normal working day. Oh, we're just going to slot someone in because they need to see. Oh, we just need to add these prescriptions to.
Professor Dame Clare Gerada: But what I what I've learned is it's so easy to blame the person slotting it in. And I never do now. It's their job. And they're usually on a much lower income than you. And try not to blame the patient because again, it's not their fault. And if I, as I have in the past, I have, because I'm human just the same, I have been angry with a patient and maybe the consultation hasn't gone the way it should have gone. I will ring up the next day and just apologize and just say, look, I'm really sorry but this. And I think that's what the the Bawa-Garba case was about. You know, it's this system error problem that if you blame the individual for things in the system, then it's so unfair. And if you're older, you know, as I am, then it's easy for me to ring up the patient and apologize because it's it's much less frightening to do that. Whereas others less experienced might feel, oh gosh, can I do that? They may not even have the details because they might have moved on to a different shift, but I think that's what I would teach people is to realize don't put yourself at risk so much. And if you are at risk and you really are at risk, maybe you're better off not seeing the next patient.
Dr Rupy: As as head of the Royal College, I I want, you're probably across wellbeing uh for for doctors in this way, but if I can make two suggestions, one is to get uh GPs more involved in uh self-care through culinary medicine. So it's where we're teaching them the skills of how to eat better every day. So they can practice it for themselves, but also that just naturally comes out in consultations and they're more confident with giving a little bit of nutrition advice, not stepping on anyone's toes. And the other thing I think are those mental health strategies which we've just been talking about now, exercising self-control, when to say sorry to yourself, being a lot more self-compassionate, and the idea of attention switching and why that's a cognitive task that can be very overwhelming, but it's a skill that can be learned and harnessed.
Professor Dame Clare Gerada: And the the final thing is to actually say that being a doctor is the most privileged job you can ever do. And it being a GP is probably the only time, only job where you get thanked 20, 30 times a day. And isn't it wonderful? Isn't it wonderful? And if I had my time again now, literally, I would be a GP. I would not change a few things. I certainly wouldn't change my practice. I'd probably, I'd probably in retrospect, try to take half a day off a week. Protected time. Protected time. Anyway, thank you so much.
Dr Rupy: I agree. Oh, thank you so much. It's been a privilege to chat to you.
