(There is a transcript of this episode below and a video with subtitles is available here.)
Dame Clare Gerada is known as the Doctor’s Doctor. She’s the medical director and founder of Practitioner Health and as well as chair of the charity Doctors In Distress. She’s also the president of the Royal College of GPs and a practising GP in south London.
In this episode you’ll hear her thoughts on what the pandemic has been like for GPs and the unique pressures they have felt.
If you want to find out more about her book “Beneath The White Coat” you can find it here.
And for information about Practitioner Health and Doctors In Distress you can visit the websites:
This is the last episode in this series. Thank you so much for listening. We’ll be back in March with Series 2. If you want to be the first to know about it you can sign up to my emails here.
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Transcript
[music]
Dr. Paula Redmond: Hi, I’m Dr. Paula Redmond, a clinical psychologist, and you are listening to the When Work Hurts podcast. On this show, I want to explore the stories behind the statistics of the mental health crisis facing healthcare professionals today and to provide hope for a way out through compassion, connection, and creativity. Join me as I talk to inspiring clinicians and thought leaders in healthcare about their unique insights and learn how we can support ourselves and each other when work hurts.
For this final episode in the series, I spoke with Dame Clare Gerada. Clare is a GP working in South London, but also the president of the Royal College of GPs, medical director of Practitioner Health, and chair of the charity, Doctors in Distress. We talk about the impact of the pandemic on the mental health of doctors, particularly GPs, and Clare’s fear and hopes for the future of general practice in the UK. I learned a lot from this discussion, including the merits of binging on Come Dine With Me, so I hope you enjoy it. To begin, I ask Clare how the pandemic had been for her.
Dame Clare Gerada: I think it’s been pretty grim for everybody. I think if we all look back, it’s been a hard time and everybody’s exhausted. Most people I know are ill. I’m ill, I’ve just had a flu but most people I know are ill, they’re either mentally ill, physically ill. I don’t think it’s bull. I think we’ve got to be honest. It’s been awful.
Paula: What impact do you think these experiences have had on doctors’ mental health?
Clare: Well, I can tell you the impact because we run a service for doctors and dentists, mainly doctors with mental health illness from across England, now before the pandemic and compared to the pandemic year. For the first 10 years of the service, we had the same number of presentations as in the year of the pandemic, which I take March 2020 to April 2021, and a slight denominator change, but not that much. We had 5,000 doctors presenting to us for care in the pandemic year compared to 5,000 in the 10 years before. The numbers have gone up in November 2021, which is our last figures, we had nearly 700 doctors, mainly doctors, we now can take other NHS staff presenting.
You don’t need much maths to multiply 7 by 12 to realize we’re going to easily get to about 6,000, 7,000, if not more by the end of a 12-month period. Most of the doctors are presenting with anxiety, which is actually what we’re seeing in our patients. I think its ranges from existential anxiety about almost the moral injury type where people feel responsible for not being able to save lives. I know my profession feels that general practice right through to the anxiety, through to losses, loss of sense of certainty, loss of family, friends. Anxiety is the overwhelming emotion that we’ve seen amongst doctors.
Paula: What about in terms of GPs in particular?
Clare: Oh, yes. GPs represent about 60% of our referrals and yet they only represent about 30% of the workforce. Of course, we can see why. At the time we’re doing this podcast, GPs are having projected into them as a profession, all the anger, and loss, and fear, and loss of certainty from everywhere from patients, the public politicians, but also from acute hospitals, from trusts, thinking that we can do it all, and so we are having to contain this and we can’t, because we can’t create miracles. This is what I mean about moral injury. The GP is desperate to make things better but can’t and what happens is you end up in a form of collective depression.
I think my profession is collectively depressed actually, and you have low self-esteem, you feel worthless and hopeless as a profession, and then, of course, individuals feel the same in various degrees. For my profession, I think we’ve had the worst of it. We’ve had the heroes and heroines in ITU trapping for staff because of course, they did a good job, but there they were with a visible manifestation of heroism, and us not. I put this mainly to the language.
We have a language of war and when you’ve got a language of war, it’s very difficult to see what’s being done by essentially the home front, which is the GP, and you have the language, you even have uniforms and which is, of course, PPE and all the uniforms that are worn in hospital. My profession has really struggled because of what the GPs want to do, they want to make things better and they can’t.
Paula: I know from the GPs that I’ve worked with over the last year or so, that there’s also a sense of isolation.
Clare: Again, whether we are seeing face-to-face or remote, we’re working in boxes. The thing about being a GP is it’s a relational activity that’s done between people, between doctor and patient, between doctor and nurse, between doctor and doctor, and we’ve turned it into an isolated activity. Many have felt isolated, many have felt those lovely moments you get in a consultation. Even now, I would be doing every consultation now with, “How are you doing?” I’m going where you’d have that tiny bit of small talk at the end of the consultation, which doesn’t happen.
It’s become a sort of utilitarian activity, which is not what we went into medicine for, and more so in general practice, because we have rightly moved most of our consultations digitally, rightly. You can’t catch COVID from a computer and the idea whilst hospitals are shut for face-to-face predominantly that GPs should be somehow different is a nonsense.
Paula: I guess there’s a couple of things picking up there which echoes what I’ve seen in my work, there’s something about the isolation. For those working in hospitals, I think what I’ve heard is what has got them through and helped them to face what they’ve had to face is a sense of the team, and the camaraderie, and the support that they’ve been able to access in that sense and that hasn’t been available for GPs. That there’s no way to hand over things, the workload has to be done by you, and that there’s no team to pass that onto.
Clare: I think the public don’t realize, we’ve got about 50,000 GPs, we’re about 20,000 short, so we’re almost half as many short, hospitals they’re about 150,000. We have no training-grade doctors, we have about 4,000, 3,000, but most of those are tucked up in hospitals and also we treat them like trainees. We treat them like trainees, they’re basically supernumerary till the very end. We have to do everything. I know this isn’t about this, but I think the days of the omnicompetent GP, the omnicompetent doctor who can do all to all to great degree of complexity on their own is gone, and I think until the system realizes that it has to change, not GPs.
In fact, I take their hand off to GPs, they have flexed, and worked, and learned, and adapted to meet all the requirements that they’ve had to over the last two decades. In so doing, it’s become the norm that we do more, to more, to a greater degree of complexity. I think we’ve now got to say no, that we can’t do it and we can’t do it. It’s not about saying no, we literally can’t do it. I think that’s what’s causing my profession to be depressed. It called to, its idolized past and an uncertain future and through no fault of its own, it can’t deliver because there aren’t enough of us to deliver.
We talk about the feminization of the workforce, well, there’s a feminization of the entire workforce across hospital and secondary, though, of course, I’m in care, but of course in hospitals, it’s sort of covered up because it’s only a certain specialties and also they have the junior workforce and they have what’s called staff and associate grades, so it’s not as apparent, but they too have a feminized workforce in most of the specialties. You’ve just got to get used to it. Women have wombs and wombs contain babies, and women tend to look after their elders, and women tend to do the home care. We know that from all research, even during COVID.
I think as the young people will say, “Get over it. That’s what happens.” Either you ban women from becoming doctors, which should be ridiculous, or you get over it and realize for every single male doctor retiring today, we need to replace them by 2.2 doctors, male and female, because of course, the workload is expanded. That I think is why the rate of increase has increased in terms of referrals to my service because we’re not being counted as one of everybody, we’ve been singled out to blame.
Paula: So those pressures around the increasing workload, the complexity of the workload, their sense of isolation, and as you said, that kind of very public-facing, taking the brunt of a lot of projected anger.
Clare: It’s also our own making. We have promised so much over the years. We have been there. I talk about, there are three pillars in society, or at least, there were, your local primary school teacher, your local faith leader, and your local GP. You tended to engage with each one of those in different ways. It’s difficult now to engage with your local GP because we’re not the same as we were 15 years ago. We have moved on. We are much more utilitarian, we are much more transactional. I think we should have spotted this. Because what most people want is a GP who’s there for them.
It’s a mix, but I think to blame us for a systemic problem is unfair, and it’s actually creating more despair and more departures, and fewer people coming into the profession so it’s a self-fulfilling prophecy.
Paula: What do you think needs to change?
Clare: Well, it certainly can’t just be little changes. I know what needs to change, we need to rebalance the funding between primary-secondary care and primary care gets 8%, secondary care gets 92%. We need to reform hospital and acute care, not primary care, we need to reform what goes on in hospitals. Hospital have to care for patients outside the hospital. The idea you discharge a very sick patient to my care is ridiculous, absolutely ridiculous. They need to be creating a hospital at home. They need to be creating transitional teams.
For at least a fortnight after discharge, they need to be creating enhanced services for patients with complex comorbidity and we need to be training GPs for longer and also getting other doctors trained in general practice. We need to stop as I said, being the omnicompetent doctor in the community, and we need to stop doing hospital work. It’s not my job to do bits that the hospital can’t or won’t do. I know what needs to be done.
It’s whether there’s a political force to change it but there has to be because if it doesn’t, then I think we’re on the trajectory of losing general practice, which would be very sad, considering it is the jewel in the crown. It’s the NHS, which is what other countries emulate and we were the first to get there 70 years ago.
Paula: Do you feel hopeful?
Clare: I’m a hopeful person. I am a hopeful person. I think every 20 or so years, there is a crisis in general practice, and we emerge from it stronger and I’m hoping this will happen there.
Paula: Just stepping back from the pandemic a bit and maybe thinking more broadly about doctor’s mental health, could you tell me a bit about how your passion for doctor’s mental health developed?
Clare: Yes, thank you, Paula, it didn’t really develop. I never had a passion for doctors’ mental health, actually. What I had a passion for or what I was interested in, I’ve always cared for people on the margins. When I first qualified, I looked after intravenous drug users. Then the homeless. Then drug-using pregnant women and refugees and asylum seekers always interested in those on the margins. I also did a lot of medical-legal work. Not a lot but I did work for the doctors who up in front of the GMC, both for the GMC and for the Medical Defense Organization.
What struck me about a lot of the cases was they got into trouble because in those days, it was around drug misuse, either they were overprescribing, or they were drug users themselves. I have these interests. I wasn’t really interested in mentally ill doctors, but I was interested in the medical-legal side of doctors. When the advert came to run this brand new service, it was actually commissioned or advertised in a very different way. It was actually modeled the NHS, so you had to first contact primary care service, and then you referred immediately to the secondary care. In other words, you did exactly what happens in general practice. I thought that’s nonsense.
What we need to do is to form an integrated service, i.e bring the specialist into the service, you work together, single budget, no referrals at all and if you need a referral, so outside then it’s handpicked. I wrote the bid just like that and put in all my experience about managing drug users and the homeless and mentally ill and how similar doctors were. I did see a few doctors because my practice is near Saint Thomas’s so there’s a few doctors registered with us. I got the contract. I was very, very surprised because I was competing against every other person bidding. I think it was from a specialist service but I put in this as an integrated, first complex service and all the bits.
I also said, it’s much better for doctors to come to a service that looks like a GP practice that smells like a GP practice, and rather than going to a big institution, for their care, and I got it, and the rest is history. The funny thing is, I was convinced that I didn’t get it at interview, absolutely convinced. I came back to surgery to my afternoon surgery, and I deleted everything to do with the bid, deleted it, and off the computers everywhere.
I Googled how to deal with loss or how to deal with failure. I found some really good sites, Buddhists, [unintelligible 00:16:02] actually. By the next morning, I was really okay, I thought, “Well, that’s okay, I’ll be able to manage patients better because I won’t be busy.” Then that afternoon, they rang me to say, I got the contract which I was delighted. Yes, I’ve been running it. I finish in March next year in March 2022 and that will be nearly 15 years.
Paula: Having not necessarily gone into that with a particular passion or interest around doctors’ mental health, you’ve obviously, dedicated a lot of time and work to supporting that cause.
Clare: Oh, because they’re interesting people. I talk about the doctor’s identity. In fact, I was listening to Gary Lineker talk the other day and about how footballers, even despite their income, despite their money. When they no longer play football, how difficult they find it, and many of them, or some of them go into gambling, into addiction, and have failed marriages. They’ve lost their way. They cannot find another way they can’t find. It’s the same for doctors.
If you think about it, as a footballer, you’ve probably been identified from about the age of six, that you’re a good sportsman, and you’re pushed into football, it’s probably about six, and you have no other identity other than a footballer. Everything about you is a footballer. The same as a doctor, there’s immense sense of identity exactly the same. It’s not just a personal identity, it’s a group identity. You’re personally attached to medicine or personally attached to football, but also as a group.
Our group identity is that of doctors and their group identity is that of football. When you have this powerful identity. I wanted to understand, so this is how I understood why doctors who have so many positive predictive factors have such high rates of mental illnesses because this massive identity both protects them, but also puts them at risk of mental illness. The way it protects them is as you create that identity, you learn the rules of engagement, which is you don’t take time off sick, you support your peers, you do long hours.
Again, if you think about with football, their group identity, which they learn is you work despite injury. All the things that we know. It protects you but at the same time, it inhibits doctors from seeking help because part of that identity is that you don’t become sick and you expunge the doctor who’s sick. Now, less so today and I think COVID has changed it but certainly before, doctors would boast how they’d cycled into work with a broken leg. I cycled, I’ve got knocked over off my bike on the way to evening surgery. I wheeled my bike back to the surgery I just left. Took a taxi to the surgery I was going to. Did the entire clinic. Got a taxi home and crawled up the path with a broken foot, very badly broken foot.
I thought to myself, not then but years later, why on earth didn’t I just ring up and say, “I’ve been knocked off my bike, I can’t work?” Again, it’s because of the sense of identity and it might not be that they would have said, “Oh, you’re a stupid idiot,” but it’s so internalized that you would have felt the stupidity. This is what I write about. This is what I want to understand. The same with addiction why do doctors become addicts? Now we know why they become addicts because they have close contact to drugs but they also become addicts because it gives them a sense of power to be able to take the drugs. Because there’s a sense of becoming a different sort of person when you take drugs.
I really became interested in doctors and at the same time I was training to be a group analyst and so I was learning the psychoanalytical underpinning and it all fitted with doctors.
Paula: I’m interested, you said that, you’re wondering whether COVID has changed something of that perspective around, I guess doctors’ invincibility to illness?
Clare: Oh, I think it’s fundamentally changed. I think doctors are no longer willing to sacrifice their lives to the service of humanity. I think we’ve seen that because doctors have died and when you see doctors dying and not the same proportions, but certainly in high proportions and the fact that doctors are becoming sick, the fact that doctors are becoming depressed, it actually breaks that bubble a little bit. That actually we are like everybody else.
Now that’s very sad because if you break that fantastic collusion that Thomas Mayne talked about, when he was talking about therapeutic communities, there has to be a fantastic collusion between the doctor on the pedestal is invincible and the patient who needs help underneath somebody to hold their anxiety against death. We’ve broken that. I think that’s again, feeding into this anti-GP business because who’s holding that now for people, who’s holding the hope?
The number of times I’m asked by friends, “Do you think we’ll have another lockdown?” The only reason they ask me is because they think because of my role as president, I must have inside information and I can give them hope. I say, “No, I don’t think we’ll have another lockdown,” but I don’t know anymore than they know. What they want, and you must see this, Paula, in your work, what they want is for you to give them hope to contain their anxiety.
Now, doctors can’t do that anymore. We’ve been exposed to the same illness as everybody else, and it’s the first time in history, well really since the Spanish flu that we’ve all been exposed to the same illness and the same treatment all across the world, exactly the same at the same time. I think that fantastic collusion has burst. I think doctors themselves, all doctors are no longer willing to sacrifice themselves, their families. Remember, medicine is predominantly female. Million out of 1.2 million staff in the NHS are women. Women don’t want to be taking COVID home to their families so they feel guilty.
I think it has, and I think we need to discuss it much more in the wider arena about what does this mean and is it going to go back to normal, because if it isn’t, then I think we need to have a new health system.
Paula: I’ve been surprised when I first started this work last year, I was expecting, particularly with, I’ve done a lot of work with the Intensive Care Society supportings and their members, and I was expecting there to be a lot of anxiety about people’s own safety in their work and having to go into work and put themselves at risk because that was the things that was foremost on my mind, but what I was hearing was much more anxiety about not being able to deliver good care to patients and denying patient’s access to their families at end of life and those really painful stuff.
I guess I wondered whether there’s something about a really useful defense against the existential anxiety of facing your own mortality in your work and not feeling that you have any choice around that, that almost to acknowledge the risk to yourself would make it very hard to continue to carry on.
Clare: Yes, but I think you said last year, I think things have changed since last year. I think it fundamentally changed since last year. What you describe as more injury and that was at the forefront of people. I think things have changed. I think the profession is exhausted. Everybody’s exhausted. Teacher’s exhausted, social workers, bus drivers, taxi drivers, everybody’s exhausted. We all need three weeks sleep which you can’t have, but it’s the doctors that we project into them, the magical belief we can keep us better.
That’s what I’m saying about the responsibility that we have and it is predominantly the GP because it boils down to the GP, because it’s the GP that most people’s relationship with doctors begins and ends.
Paula: Is some really quite fundamental shift in our relationship to healthcare and doctors’ own relationships to their work?
Clare: I think so, Paula, but what I’m saying is I think we need a discussion about it and I think we need to be open and honest and say, is this something that’s going to last, or is it going to go back to normal? What does it mean? Is it a good thing? We’ve always wanted doctors to be like everybody else. I’ve actually always argued that they shouldn’t be like everyone else. That actually, if we want doctors to do the unpotable things that we request of them, that they have to be shored up with psychological defenses, therefore they have to be different. It’s having a debate. Maybe we’ll be better now this time next year.
Paula: Again, just thinking more broadly about some of the things that get in the way of doctors seeking help when they are struggling and how you address that in practitioner health.
Clare: Well, I think we’ve spent 15 years trying to address and I think we have got quite far in that now. It’s about fear, it’s shame mainly, it’s fear and shame, shame of admitting that you are vulnerable and need help and fear that it will have consequences on your job. I think we’ve moved on that, but I still think there are issues. I think the issues are around doctors now about having the time to care for themselves. The internal resources, the exhaustion, if you’re really tired, really depressed is difficult. It’s like the analogy of the drowning man. If your head is literally, your nose is literally just above the water, you don’t have any energy, but just to keep your nose above the water.
I think that’s what we’re seeing certainly with GPs, if there is so demoralized and despondent. They haven’t [unintelligible 00:26:39] said we get most of them coming, but I think there’s vast numbers out there.
Paula: Yes. I wanted to ask you whether, part of your role is myth-busting that sometimes people have fears that are unfounded or whether there are aspects of the system that do punish people most of the time?
Clare: Yes, I think they are not unfounded. I think if you admit in the wrong place, you’ve got a mental illness, I still think you can end up running into serious issues. Some things, for example, at its worse, let’s say it’s worse. If you admit if you’re a gay man and you’re using chemsex drugs and you admitted at your HIV clinic, then the chances are you are going to get referred to the regulator for using the illegal drugs, which is not very good for the doctor because it will stop them going to get care et cetera, et cetera.
Right through, if you admit that you are depressed or drinking too much or having suicidal thoughts at work, some people might overreact and report it up the line, and nobody takes any responsibility. I think there are still problems about where you present it, our service, there is no problem. You can have a confidential service. We talk to you clearly if there are issues that need to be disclosed, we talk to you, we help you do it et cetera, et cetera, et cetera.
Paula: What message might you want to give to a struggling doctor right now?
Clare: I’d say, first of all, seek help from your friends. Try and find those support systems closest to you to offer you support. Remember, you’re not alone. It’s a difficult time for everybody and you’re not alone. If you really are struggling and can’t get any respite them, please ring out practitioner health, www.practitionerhealth.hs.uk and we are there to provide you with treatment. My charity, Doctors in Distress, actually is for all healthcare staff. We are there to try and support healthcare staff who up around the emotional aspects of their job by providing safe spaces, safe reflective, peer-led, but facilitated spaces. It’s a lovely place.
We’ve had doctors and nurses with long COVID. We’ve had doctors who are stranded in this country. We’ve had black doctors who had black doctors groups, so please don’t struggle in silence. It’s the worst thing I ever hear is if a doctor who has taken their own life. I think to myself, if only they had come to my service, not that I’m not Jesus. I might not be able to do things, but please seek help.
Paula: I’m just wondering for you, Clare, you obviously have a very full and varied working life. I’m just wondering what aspect of that are more likely to hurt for you?
Clare: Hurt for me, hurt?
Paula: Yes.
Clare: In what respect?
Paula: I guess what aspects of your work are likely to stay with you in a troubling way, if any?
Clare: Well, the thing that stays with me most, most, most is my profession, GP, I feel desperately sorry that my profession is being abused in such a way, and that we’ve got it wrong, that something is going so horribly wrong, and that means patients are suffering. My patients are suffering, this profession is struggling. I don’t know how to fix it. Now, if I was in charge, really in charge, if I was the prime minister, I think I would be able to fix it. I think you’d need a really- it’s a bit like forming a COVID advisory group. It’s like forming, lost the group that’s been running the COVID.
Then you can do it, if at a moment’s notice the prime minister can make us all wear masks, then there’s a moment’s notice. He can force 60% of newly qualified doctors to train us GPs, which is what we need. If he can make us all show our passport or our COVID passport at a moment’s notice, then he can also to moment’s notice require that hospitals looked after their patients for two weeks or a month after discharge. It requires something akin to that to make this all better, and that’s what keeps me awake at night. It’s what worries me consistently, and–
Paula: What keeps you going?
Clare: What keeps me going is the love of my profession, which is very, the other is that I adore being a GP. I think I’ve been very lucky because what I’ve done, which is what I plead to my profession, is find a place of belonging. I found my partnership. I wanted it, it was in a very poor area, it was my own GP practice actually. I got less money going to it than I had as a trainee so it wasn’t money. It contained me and I’ve been there for 32 years and it’s allowed me to develop and grow and to do all the things I need to do. I wish that my profession finds the same because actually, I think if you can find a space that can contain you, then you will. It’s one of the three, the ABC, is belonging, is one of them.
It’s a space that you belong to. I love being a GP. Look at me, at 62, I’m not doing full-time general practice, but I’m certainly full-time working. If not more, I’m hoping to drop down a day, a week next year. That’ll be the first time ever that I’ve dropped down a day a week, ever. It’ll be interesting and I’m going to put an out of office on my diary and I will do abs, I’ll be noticing people who have out of offices on their diary saying, “I don’t work.” I think, okay, that’s what I’m going to do, and I’m not going to work on a Monday. I’m going to take that day off and go swimming.
Paula: I was going to ask you for like, what are the things that support you in terms of your [crosstalk]?
Clare: I used to rumple and then I damage my knees, I can’t run so I recently took up swimming. I used to hate, I didn’t like swimming pool, but I decided I have to go swimming so I found a really nice swimming pool locally and I love it. When I’ve got this Monday off these Mondays next year after April, I’ll go once a week, maybe even twice a week. Then I’ll come home and I’ll meet friends for coffee. I’ll do all those things people have talked about and I’ve never been able to do. I will have day off a week. I can’t wait. Can you imagine? I’ve worked since I was 23, so it’ll be 40 years and 39 years finally get a day off a week.
Paula: I read, I think, Clare, you tweeted a while ago about watching Married at First Sight [laughs] and I wondered if those pursuits are part of getting you through some–
Clare: Oh God, yes. I watched Come Dine With Me back to back. Oh gosh, yes. I watched Australia Married at First Sight and I was intrigued by it and I watched it. I must have watched it on Saturday back to back episodes. Then I looked up how many of them remain married and it’s a disaster, by the way, the numbers that remain married, it’s really a disaster. It’s really, really, I think one in a hundred, however many they get going through. What intrigues me about Married at First Sight, the same as Come Dine With Me in a way, is these are group activities.
If you’re interested in groups, people, and you start to see how behaviors happen in groups and that’s why I like Come Dine With Me because they put four different people together, really different people. Then you see the tensions that go on and you also see, and if you watch it very carefully, Come Dine With Me, there’s always one that ends up as a scapegoat. There’s always one that ends up as a leader. There’s one that ends up as a chairman, and then the group, we don’t see it all. We only see the bad bits but it is fascinating, and the same as Married at First Sight.
What amazes me is how one ever meets one spouse, without all these. I met my husband and we met and over the Sectioning Mental Health Act, sectioning on the floor of the Mortally Hospital. Within a month, we were engaged and I think to myself, “Can you imagine if we’d gone through all these psychological bits and pieces, we’d never have a complete opposite.” I like sport A [unintelligible 00:35:29] doesn’t he likes to watch it. It’s bizarre but no, I love that. I love it. I’m watching at the moment, back to back, Masterchef, but that’s different.
Paula: I think there’s something about that the emotional compellingness of these shows that when you have got a very intense working life in a funny way, give you some respite, give you a break, they need to be compelling enough to occupy your mind and brain but distant enough so that they’re not continuing to traumatize you.
Clare: I think it’s because they’re mindless actually. Come Dine With Me when you watch enough of them and believe me, I’ve watched enough of them, they’re all the same. There’s the same formula. You can also predict who’s going to win so it’s never the first person. It’s exactly the same formula so it’s very, very, very safe to watch this and you’re right, there’s all the tensions and everything that going in between, but the formula is the same and it’s so consistent that you can watch it. You don’t even have to watch it. It’s not about the food and if you watch Come Dine With Me, the food is irrelevant.
It’s not the person with the best food that wins, nor the person with the best entertainment. It’s always something very different. I have to say I’ve stopped watching Married at First Sight because it is such rubbish that I couldn’t bring myself to watch more than half a day of it. Come Dine With Me isn’t. Come Dine With Me is a very interesting program.
Paula: My favorite show is Gogglebox. [laughs]
Clare: Oh, am not watching, what?
Paula: It’s really fascinating. I think it for lots of those reasons and it’s so interesting because you’re watching other people watching TV. Just that sense of their interactions and how. Yes, I find it really lovely. Clare, is there anything else that you wanted to say that we haven’t covered that–
Clare: Yes, I want to add, I hope I haven’t sounded hopeless. I think there is hope. I think there’s always hope and if I look back at my profession every 20 so years since 1946, we’ve predicted the end of general practice and it’s still there and it’s still thriving in many ways. I just don’t want us to think that I’m hopeless. I am very hopeful. I also think sometimes it comes with age so what people listening to me have to factor in is that I am getting to the end of my career and when you get to the end of anything, you begin to look back with sorrow because not just do you wish it was different, but you look back and you idolize the past.
I think you’ve got to be very wary if you’re listening to this, for listening to me and seeking any nuggets of wisdom because it is tinged with this sense of in my day. I hope I don’t do that but I know, of course, I don’t do that. The second thing I’d like to say is, yes, my charity and, Doctors in Distress, I’ve recently written a book called Beneath the White Coat: Doctors, Their Minds and Mental Health, and all the proceeds are going to the charity and the Doctors in Distress is not just about doctors and Beneath the White Coat is not just about doctors.
If you want to learn more about doctors’ mental illness or why people get over-identified or about bipolar disorder and doctor addiction or how to stay out of trouble, or if you’re in trouble, how to not dig more holes and please buy the book because the more books you buy, the more proceeds go to the charity and the more doctors lives, we can stop either killing themselves or becoming mentally ill.
Paula: Thank you, Clare.
Clare: Thank you so much, Paula.
Paula: This is the last episode in series one of When Work Hurts. Thank you so much for listening and supporting the podcast. Please do share it with others, post about it on social media, or leave a rating and review. We’ll be back in a few weeks with series two, which continues to explore how we can support ourselves and each other when work hurts, through compassion, connection, and creativity. Until next time, take good care.
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