Wellbeing for GPs: It is time we addressed doctors' unmet needs

By Dr Jennifer Napier on the 17 July 2017

As GPs we have all come across PUNs and DENs. But it's now time we started to consider DUNs (doctors' unmet needs), says Dr Jennifer Napier.

Instead of noting PUNs and DENs, spend a few working days noting feelings and DUNs

Patient unmet needs and doctor educational needs - PUNs and DENs respectively - could be our prime focus in times of plenty, when our own basic needs were more easily seen to. But now the time is ripe for a new concept - we urgently need to get in touch with doctors’ unmet needs (DUNs).

Things have shifted considerably such that our working lives stretch many of us to the limits of our capacity. The job demands-resources model which I’ve mentioned in an earlier article shows that stress results when the demands of the work situation are not balanced by adequate resources.

Overload of demand

In our current professional lives we are in circumstances of intense strain with a huge overload of demands compared to the resources we have to support us in our role. We are working with financial and time constraints, yet with increasing complexity, more consultations, more demanding patients, more data requirements, etc.

This means that many GPs are suffering from stress, depression, anxiety, physical complaints and, in the worst cases, taking their lives.

These are systemic issues and we can each contribute to the pressing task of raising these concerns at a national level. However, we also need to find our own means for supporting ourselves right here, right now.

It is time to shed our mantles of tough invulnerability and get into contact with our needs.

Recognising our needs

According to Marshall Rosenberg, the originator of non-violent communication, we all share the same fundamental human needs. These include very obvious needs like food, water, sleep and shelter. Examples of our less tangible needs, which may be hard to meet in the working day, include fun, ease, clarity, choice, recognition and movement (for a full list see the book).¹

Our feelings provide clues to whether a need is being met or frustrated. When we get better at paying attention to our ‘gut-level’ emotional life, rather than being caught up in thinking and analysis, we are in touch with our direct experience.

At a recent workshop I ran, one GP recognised that she had a compelling sense of duty to keep up with every new bit of medical knowledge, so that she knew the complete list of differential diagnoses for every symptom. But this meant a heavy, limitless burden of reading.

When she looked at what feeling attached to this activity, it was anxiety, and still it was not resolved, no matter how much reading she did. Digging deeper, she realised that the need underlying this anxiety was the need for a sense of safety.

This recognition led to a powerful ‘goose-bump’ moment for many people in the room. She felt unsafe about the risk of doing harm to a patient and maybe losing her licence to practise. Once she had identified the need she could work out other ways of addressing it. In fact, even recognising the need gave clarity, and helped her make space for it, so that she could take a more considered approach to meeting that need.

Taking our needs seriously

Being compassionate to ourselves means taking our own needs seriously and trying to meet our needs as far as possible.

A quick caveat applies at this stage, which is that needs are more fundamental and are distinct from the strategies we employ to meet them.

For instance, money is not a need. But acquiring money could be a strategy that someone might employ to meet a need for safety, recognition or contribution. When we are in touch with the level of needs, we have a greater sense of clarity and vitality about what it is we are seeking at any point in time and are more likely to be guided by our values.

How about, instead of noting PUNs and DENs, you spend a few working days noting feelings and DUNs? Then see what choices proceed from being more closely in contact with the need itself, rather than a knee-jerk reaction to thoughts or feelings.

Dr Jennifer Napier is a GP with special interest in occupational medicine. She has researched wellbeing and workforce issues, and works through Contextualyse to train and consult on how to create healthy, productive workplaces.