Unhappiness among doctors is partly related to a feeling of a lack of support, but doctors are not all unhappy all the time.8 General practitioners have a job with a regular income, security of employment, and an opportunity of meeting a wide variety of interesting people many of whom appreciate their help. Anecdotally, general practitioners recognise that organisational changes in out of hours cover have had a positive impact on their lives. One report indicates a thought process that may not be uncommon: "Why do I stay? Well, when it's good it's very, very good, and when it's bad there is always tomorrow" (M Cupples, personal communication). The GMC emphasises that doctors have a duty to make their patients' care their first concern. For this to happen, it is essential that all concerned realise that the doctors' care of their own personal health is inherent in this duty.
Challenge of culture, conscience, and contract to general practitioners' care of their own health: qualitative study BMJ 2001;323:728-731 ( 29 September )
The perceived need to portray an unrealistically healthy image is stressful and a barrier to appropriate self care
The emotional response to personal illness can produce an oscillation between panic and denial
The working arrangements of general practitioners reinforce a culture in which their own and colleagues' distress is overlooked
Karen Appleby, who runs Contact, a stress management service for doctors in the West Midlands, outlines the structure and function of the service
Morale among general practitioners: qualitative study
exploring relations between partnership arrangements, personal style, and
workload BMJ 2002;325:140 ( 20 July )
Solutions to the problem of low morale need
integrated initiatives at individual, partnership, practice, and
policy levels. Improving partnership arrangements is a key intervention,
and rigorous action research is needed to evaluate different
approaches.
What this study adds
Morale in general practice depends on several factors; the dynamics of the relations between the factors is more important than any one factor in isolation
Partnership arrangements are a key factor in mediating between external workload pressures and individual general practitioners' experience of work
Practices need the time, skills, and resources to create supportive working environments to manage workload and change effectively