Sally Higginbottom – A View from General Practice

Hello, my name is Sally Higginbottom, I’m a GP at the James Wigg Practice in Camden. I was asked to put together a few thoughts about our emotional journey during this difficult time. I’ve been really struck by the strength of my own emotional reaction to the work we’re doing and the impact it’s having on us. It feels like the pace of change is just completely overwhelming. The way we work one day will be very different to the next day; an email you sent a week ago will no longer be in any way relevant because everything has changed; there are new IT systems at the rate of several a week; and the way we relate to our patients seems to be changing in front of our eyes.

In all that it feels I have been going through something of a grief process and it feels like that’s something that’s been happening to me individually and also through the system. It felt initially like there was a denial phase where it felt like we decided things were different in China, it couldn’t possibly happen here, we wouldn’t go into lockdown like Italy. Yet here we are with 20,000 people who have died in hospital and we estimate many, many more outside of hospital.

I feel I’ve been very unreasonably angry with family and with colleagues, because they are the only people I can get to talk to at the moment and because I’m angry with the situation. I feel very sad about what we’ve lost. It feels like some aspects of primary care are never going to go back to how we were, a sense that we would have face-to-face interactions as our primary means of work has probably gone forever and that feels like a huge loss to me and it feels now like I’m bargaining with family and with colleagues about how we go forward from here.

There are other feelings too. I feel guilty about not being closer to the frontline, whatever that might be, and being removed from my patients’ frontline because I’m not with them and I’m only communicating, or overwhelming communicating, over the phone or by video. I feel really disconnected from what’s going on in their lives and also concerned for my hospital colleagues. I feel a loss of identity really as a doctor, who am I if I’m not seeing patients? What do I do when I go to work and it’s just an endless telephone list? It feels very odd and I think there’s been a big challenge to our boundaries consulting from home as many of us have done, either intermittently or on the medium term, it’s very difficult, it makes it much more difficult to contain your emotions, contain patients emotions, without immediate access to our colleagues, and in your living space it’s very difficult to have some of these consultations.

We’re also not saints and I feel very uncomfortable about the applause on a Thursday night. It feels better now that it’s more widely focused at the whole range of keyworkers who are keeping the country going at this very odd time. I think I’m a professional who is paid to do a job, which I’m doing to the best of my ability, but I think the way the NHS is currently being seen, it’s like a pendulum has swung radically to a slightly deification, and I’m not sure that’s very helpful for the NHS. I think it’s possibly helpful for the country as it enables people to feel a bit safer if the NHS is omnipotent but I’m not sure it’s very helpful for us.

It’s really tricky, because the path forward isn’t clear and that makes us uncomfortable, and the number of unknowns across all of our personal and professional lives are now huge. We’ve all probably been through our diaries crossing things out over the next few months but we don’t know when that will stop, when do we start experiencing some things we would consider to be ‘normal’ in life? It feels much more unknown than I have ever experienced, I think that’s true for a lot of us.

I think it will be helpful to think about the light at the end of the tunnel and it’s hard when you can’t see exactly where that is, because we don’t know how long the tunnel is and we don’t know quite what the world is going to look like on the other side, but someone much wiser than me suggested that just because we cannot see the light at the end of the tunnel, doesn’t mean it’s not there, but just that perhaps it’s round a corner. And I wonder if that’s where we are, that we will come out the other side of this, it will be different, but we don’t quite know how and that does feel uncomfortable. I think it’s just best to say that it feels uncomfortable and then that perhaps will help us to get on with our day. Bye bye.

Dr Sally Higginbottom is a GP at the James Wigg Practice in Camden. She is also the Programme Director for the GP SPIN Scheme and a trainer and appraiser. Sally shares her thoughts about our emotional journey during this difficult time, from the perspective of General Practice.