Editorial

Last year, I wrote a hopeful article entitled ‘The future – burnout or resilience?’ (Holland, 2015), in which I discussed the many positives of a career in general practice, and outlined how we might alter our working practices to deal with the challenges we face as a profession. I concluded that approaching our work with a new wave of enthusiasm and optimism would be enough to keep us resilient and prevent us from burning out. That was, I am ashamed to say, an over-simplification and a demonstration of my lack of understanding as to what burnout is and how to manage it. This special edition of InnovAiT is brought to you to raise awareness, explain the science behind burnout, and chiefly, to help you develop the skills to maintain the long, varied and fulfilling careers I aspired to in my article.

The need for these skills could not be more pertinent than right now. We are entering the profession at a time of crisis with ever-increasing demand on, and expectation of, doctors. If we are to challenge this status quo and improve the system for our future colleagues and our patients, we must first look inward. Daily exposure to disease and suffering is amplified in the front row seat of general practice, where we know the patients, their families, and often live within the same community. We must remember that we are all at risk of burning out, and that we are no use to our patients if we cannot look after ourselves (RCGP, 2016).

The articles presented in this special edition define the problem further, and offer many definitions of resilience. A common thread is not simply the ability to survive, but to thrive and adapt in the face of adversity. They not only describe tools to manage the demands of the job, but also highlight the need to occasionally to say ‘no, enough is enough’.

The edition is divided into two segments, first: broadening understanding, and second: what we can do about it. The first article outlines the psychosocial elements of burnout and mental health issues affecting clinicians, Dr Chris Manning delivers a moving personal account of his experiences and relates them to clinical practice. He encourages us to remember our humanity and fallibility, helping the reader to recognise the symptoms in themselves and colleagues. This is followed by a biochemical perspective presented by Professor David Peters, who takes a look under the bonnet and explains what is happening to us at the cellular level when we are burnt out and when we are building resilience.

Next up, we have an article from Balme and Gerada who review the evidence behind organisational and personal resilience interventions, in particular they evaluate the Practitioner Health Programme (PHP) in London. With increasing referral rates and a changing patient demographic there is a clear need for PHP and similar schemes. Dr Olivia Jagger then takes a closer look at how leadership can boost resilience. Her case study describes how leadership is as much personal as organisational, and how the relationship between leadership and resilience skills is mutually re-enforcing.

Recognising that developing resilience skills is important, many courses and training packages have been developed. Lynch et al. appraise their innovative new REFRAME programme, presenting their initial evidence in the next article. This is followed by Dr Chris Johnstone’s Top Tips for maintaining resilience and a useful tool-kit for managing on a day-to-day basis. These evidence-based self-help practices not only protect our own wellbeing, but also give us the capacity to help others.

The penultimate article describes burnout in greater detail, and gives terrific insights into the mind-set of doctors on the road to mental ill-health. Here Dr Daniel Jones also discusses the warning signs, how to avoid burnout, and an extensive list of where to go for help. Finally, Professor Johnny Lyon-Maris delivers a challenging article on the art of saying ‘No’, while keeping your patients on-board, and helping them to understand the strain the system and the individuals running it, are under.

This special edition comes at a pivotal time for the profession, and especially for those of us starting out on that path. We hope that the articles within this issue will be thought-provoking, informative and help those who are struggling see that there is help available.