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For all but the most curmudgeonly, summer is synonymous with holidays. Teachers and students abandon their academic responsibilities for the unruly, chaotic, unpredictable routines of summer break. The Dáil rises, the Seanad goes into recess and no important political issues will be debated until September. For journalists and the media, summer is the ‘silly season’, when reporting of celebrity antics are as likely to grace the front pages of national newspapers as major world events.
Every summer, since starting in general practice 25 years ago, my family and I have made our way to Connemara, my home place, for a couple of weeks of seaside living in the company of family and friends. A break that is anticipated for at least six months of the year and fondly remembered for the remainder, regardless of the weather. Not so this summer. This year, a family holiday is not possible as there is no locum available to cover the practice my husband and I run in rural Tipperary. This lack of locums, a country-wide problem, is the final nail in the coffin for many single-handed rural and urban GP practices.
The summer story this year, for many GPs, is one of long-anticipated holidays being cancelled at short notice, or reduced to a long weekend, while still providing telephone advice. GPs have survived the challenges of the FEMPI cuts and the under-sixes contract, introduced last year and still awaiting review. They have remained optimistic, even when faced with the threat of further expansion of free GP care to the under 12s. But the camel’s back is at breaking point, the final straw being the inability to get away from work for even a couple of weeks.
Holidays allow a break from routine, a rest from the demands of work, email, preparing lessons and debating political issues. Whether this involves lying by a pool with a stack of cheap novels, cycling the Wild Atlantic Way or wandering around one’s garden playing Pokémon Go doesn’t matter. What matters is shedding one’s work skin, escaping the shackles of responsibility, abandoning the need for problem-solving and planning. What matters is the experience of time and space to feel connected to others, appreciate family and friends, meet new people and reappraise oneself as a father, mother, child, sibling or friend, without the interference of work.
Holidays also feel good. Prof Barbara Fredrickson, a psychology professor at the University of North Carolina, US, has shown that experiencing positive emotions such as those normally associated with holidays broadens one’s thoughts and actions, leading to greater propensity to explore new solutions, savour enjoyable experiences and connect with others. These effects remain long after the actual positive experience is over. This may be why workers who take holidays are more resilient to the physiological effects of stress than those who do not, and is almost certainly the reason post-holiday employees exhibit increased creativity, problem-solving abilities, tolerance levels and energy levels than those who do not take breaks.
Every occupation, whether it is head of a political party, business owner, construction worker or doctor, has its unique stressors. Each individual deals with these in their own way but everyone benefits from regular periods free from the work routine. GPs deal with a multitude of clinical and administrative problems daily, making hundreds of decisions in the course of a single surgery. Sustained, safe and effective practice is not possible without regular holidays. GP registrars and medical students who see their role models and mentors suffer the consequences of work pressure without reprieve will not follow blindly into the same situation and are already deciding that Irish general practice is not a viable career choice.
Established GPs have to give careful consideration to the sacrifices one can continue to make to maintain the current practice of providing personal care 24 hours a day, 365 days a year. When a plane is going down, the advice from the crew is to first put on your own oxygen mask and only then assist others. Oxygen masks come in many forms for GPs — possible early retirement for those who can afford it; emigration for those who cannot and have college fees and mortgages to pay; a move to public health or the private sector for those who would prefer a salaried position; professional landlord for those who have invested wisely and wish to enjoy some leisure time before becoming incapacitated by illness or old age.
A new story is emerging among GPs in response to these changing circumstances. The realisation that we are not responsible for providing care against all odds is liberating.
The realisation that we need our own ‘oxygen masks’ in order to help others is making us more assertive about our own health needs. Younger GPs may have no choice but to accept salaries and I wish them and their patients luck with that.
Single-handed urban and rural GPs will soon be history. We have done our best but perhaps it is time to make way for a new type of general practice.