GPNI Wellbeing: Boundaries by Dr Stephen Harte

Dr Stephen Harte, GP and Executive Coach, explores how to deepen understanding of our interactions with colleagues in the workplace, by addressing some common problems with boundaries. Part of the GPNI series on Wellbeing.

June 2020 Update

Managing Transition

As the Covid situation progresses, the challenges are different now. When engaging with our patients we have a heightened awareness of the effect lockdown has had. For example, we are vigilant to the signs of domestic abuse, but also to the more generalised impact of changed life flows. These include loneliness, financial concerns, and missing friends or colleagues. There can also be a drop of that individual sense of purpose, and removal of the soothing comfort that normal life previously gave us, with its well understood boundaries and structures.
Now for the moment of honesty – every one of us is at risk from some of these factors which could surely have an effect on us. Personally speaking, I liked the way things were before. As a locum I had my practices where I was known and where I felt comfortable, and I knew my role within them. Confidence, enjoyment, and a sense of routine – all very comforting. The reality for me is that this looks different now – I’m asking questions about what the new normal will look like, and where do I fit? Or do I fit? Equally partners and salaried doctors must confront the questions over what the future will look like and how we will move forward from here. GPs who have returned to practice to assist will have decisions to make around their role, while our leaders have had to shoulder criticism as well as praise for the macro elements to the response. They have had to make courageous choices, and they well know the truth of the saying, ‘when you decide, you divide’. We won’t all agree with every decision made, and there is a personal cost to leadership – I am grateful for those who are carrying that.  Change, change, change!
I want to encourage you to hang in there. There is a natural cycle to transition.
When developing a workshop for GPs on transition, I landed upon a few key considerations or principles, especially through reading a book called ‘Managing Transitions’ by William Bridges. He argues that ’change’ is situational (e.g. ‘we are moving to telephone triage’), but ‘transition’ is psychological. When a change happens without people going through a transition it is just a reconfiguration of their environment without care for the most important resource involved (i.e. the people actually being aligned with it). Bridges suggests that there are 3 phases people go through as they internalise and come to terms with the details of the new situation that is coming: 1) Ending, losing, letting go, 2) The Neutral Zone, 3) The New Beginning.
All three stages are worthy of consideration, but in this piece perhaps it would be useful to consider that first stage, both as you consider your own response or that of your practice team.
1)Ending, Losing, Letting go:  This is a time when you need to help people deal with their losses because our identity is wrapped up in what we do.  Recognise the emotions of change –  we can get angry, sad, depressed, frightened, confused, anxious, or a mixture of these. They are all signs of loss and grieving, which is a natural series of events people go through when they lose something that’s important to them. Overreaction is normal.
Teams often overlook the ‘letting-go’ process completely and do nothing about the feelings of loss generated. This is frequently to do with a resistance to dealing with their own and others’ emotional reactions. Doing so virtually guarantees that change will be mismanaged. You may scorn this view, as we all have a different tolerance for change and some people actually thrive on it, but it is very real and will affect your team. Lowering your resistance to this is an essential first step in transition management.
Action points:
 – In the early stages you need to deal directly with the losses and endings rather than persuade people of the benefits that the change may bring to the organisation.
 – Identify exactly who is losing what? What’s over and what isn’t?
 – Good questions to ask include, “What’s different now, what do you miss, what did you have to let go of?”
 – Respect the past. Can you find some way to mark the ending of what was? (NB don’t drag it out – whatever must end must end, and lingering on this may not be the kindest approach!)
 – Model letting go – be open about weakness and vulnerability.
 – Give as much information as possible about the change that is occurring (over and over again).
 – Can you give anything back or create opportunities that allow some return to feelings of control or competence?
The next chapter of our 2020 Covid story is going to be written now. We can’t go back to where we were. We’ve learnt too much, and some of the new systems are going to make us better. However, transition starts with an ending – let’s not deny ourselves the opportunity to be real about what has been lost along the way, even as we innovate and plan the way forward.
As mentioned before, check out the wellbeing resources below, recognise what’s going on within, have the conversation. If you have ever wondered about experiencing coaching or mentoring then there are 20 trained mentors all across NI, accessible free of charge on the current NIMDTA pilot scheme. Here’s a link to the biographies. https://www.nimdta.gov.uk/general-practice/gp-mentoring/meet-the-mentors-mentor-biographies/
I wish you well.
Dr Stephen Harte (GP)
April 2020

“A job with purpose and meaning in a family setting: healing and caring for patients across generations – these are all life giving tasks. For nurses, pharmacists, GPs and everyone else in our surgeries – this is the privilege that we call working as part of the team in General Practice. 

However in my own experience this is not always how it feels. Honestly, at times I think I’m wired perfectly for it, and at others it can feel like the opposite!  

We know we do a pressurised job where the stakes are high, and there are alarming statistics about rates of suicide, substance abuse, stress and burnout. We knowingly and willingly serve our communities despite these things, but we don’t do it blindly, because this all matters to patients. Stressed-out, unhappy healthcare workers can make poor decisions that affect patient care. Of course, massive systems issues are at play in our workplace that have huge impact and can be out of our control, so we must therefore address those things that we actually can control. 

Never have these strains been as apparent as the day in which I write this, in the midst of the the Covid-19 global pandemic. The goal posts are moving rapidly, our comfort zones have been left far behind, and we rightly feel the burden of care for our families and the impact our job might have on their wellbeing. Our relational capacity and emotional capacity are being tested to the limit, and it’s important to recognise that these can differ between individuals. Recent NHS life has taught us to be a resilient bunch, and we have been well trained. Although we may have to work in a relentless manner for this time, we will pull together and support one another to face this season, knowing that it too will pass. 

I like this quote by Justin Amery, “It is an enduring mystery that doctors, who can be so caring, compassionate and skillful with their patients, can be so uncaring, cold and unskillful with ourselves”. If you want to sustain your wellbeing and be of any use to others you do need to genuinely and sacrificially care for yourself. 

Medicine attracts people who love to help others – we need to apply some of that to ourselves too. We need to take time to ask some tough questions, and listen to the answers: ‘Am I doing OK here? Is this work pattern sustainable? Do I tend to talk about my work in a negative way? Am I often drained and disconnected, or energised and engaged?’

If the answers to all of these questions is that all is well at this stage in your life, then I am pleased for you and encourage you to look out for your colleagues who are in a different place. If, like me, you’ve had periods where it doesn’t feel that good, then the next question is surely ‘what can I proactively do to manage this?’ 

Below are some resources where help is available for all sorts of specific reasons, and I would particularly point your attention towards opportunities such as mentoring schemes. These can be used for pursuing excellence and development of specific leadership skills. Another potential benefit is similar to the process whereby professionals such as counsellors are required to undergo 1 hour of therapeutic supervision for every 20 hours of practice. This is to help them remain aware of themselves as they engage with the multiple traumas of their clients. Could we not also benefit from a safe place to explore the effects of these, gain a different perspective and reconnect to a new sense of purpose? 

Another anonymous quote I am fond of is this, “See yourself so you can see others, love yourself so you can love others”.  Self care is actually another way of putting the care of patients to the fore. I encourage you to think of the long game, and invest in the wellbeing of yourself and those around you, “

Best wishes,

Dr Stephen Harte (GP

Limitations, I can’t do everything!

Dr Stephen Harte, GP and Executive Coach, considers how to find peace about the fact that we can’t do everything we’d like for everyone we meet.

Interpersonal Boundaries in the GP team

Dr Stephen Harte, GP and Executive Coach, explores how to deepen understanding of our interactions with colleagues in the workplace, by addressing some common problems with boundaries.

Assertiveness in General Practice – GPNI

Dr Stephen Harte shares some thoughts on how to develop appropriate assertiveness in General Practice and beyond.

Key Resources

NIMDTA GP Mentoring 

 The NIMDTA GP mentoring scheme is continuing and sessions will take place remotely. Follow the link to find out more and register.  

Free Access to Wellbeing apps for all NHS Staff

NHS staff can access a range of apps for free until the end of December 2020 to support their mental health and wellbeing

RCGP NI Wellbeing

 One page document on Useful contacts for wellbeing including occupational health numbers for trusts. 

RCGP Wellbeing

Link to a range of wellbeing resources provided by RCGP. The majority are available to GPs in Northern Ireland

Staff Health, Safety & Wellbeing

 NHS Employers advice page for healthcare staff 

 Leadership Centre

 20min ‘Care & Support Space’- a  virtual ‘safe space though a guided coaching conversation. Email the enquiries@leadership.hscni.net to register.



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