Clinical Professor Leanne Rowe, a rural GP and co-author of the newly released 2nd edition of ‘Every Doctor: healthier doctors = healthier patients,’ offers tips for on how to maintain—or re-gain—optimism at work.

Many GPs report high levels of burnout and are at risk of leaving the profession following adverse and traumatic experiences during the pandemic or natural disasters. Generic self-help strategies are inadequate, and it is essential to engage an independent treating doctor or mental health professional in these circumstances. In the coming weeks Professor Rowe will write a series of articles on GP Health.

Maintaining optimism in challenging times

There are a number of common psychological techniques to help us maintain optimism throughout challenges. Importantly, before we try to ‘rethink’ optimism, we need to understand why GPs can be prone to pessimism.

In general practice, we are trained to be hypervigilant for anything that may go wrong. We are always preparing for the worst case scenario, and unconsciously scanning the world for threats. Additionally, we are often exposed to the deeply painful dimensions of medicine: misery, trauma, injustice, anger, bullying, violence and death. We are also frequently confronted with the reality of poverty, child abuse, violence, and drug and alcohol abuse that our patients and their families experience.

As our medical careers progress, it is not surprising that we can develop a negative cognitive bias that at times can transcend reality. Conditioned to be overly risk averse, we sometimes assume the worst without evidence and when it is no longer helpful. As it can feel like there is always something to worry about, it can be difficult to remain optimistic and courageous.

To counter these common thinking traps, it can help to draw on some psychological techniques, with self-compassion.

Here are some recommended approaches to help manage negative biases and thinking:

• Positive psychology strategies shift the attention away from challenging or accepting the negative to focus on the positive by practising gratitude, kindness and forgiveness. It can help us recognise and develop our inner strengths and gain a sense of accomplishment, pride and optimism by shifting attention to nurturing positive relationships and simple pleasures.
• Cognitive behavioural techniques can help us challenge our unhelpful beliefs and common faulty thinking patterns, which predispose us to feeling negative or sad. Unless we are seeking solutions, it is usually an unhelpful use of our time to allow our minds to brood or get stuck on the same dysfunctional thoughts over and over again, without questioning ‘is this thought useful or helping me?’ or ‘how are these thoughts making me feel?’

Here are some examples of common negative thinking patterns:

• • Catastrophising situations. Today was awful, terrible, horrible. If you repeat this in your mind, how do you feel? ‘Awful, terrible, horrible’? ‘I can’t stand it anymore’? Although these thoughts may feel entirely justified, what impact will they have on your short and long-term mental health? Are catastrophic thoughts useful to you in any way? Is it possible to find a calmer inner voice? How does it feel if you try to repeat the following statements? ‘Yes, it is difficult, but I have gotten through problems before and I will try to do my best’. ‘This is the most challenging period in my life, but I can connect with others to find a way through it’.
  • Black-and-white thinking supposes that situations or events are either good or bad, which is rarely the case. On a daily basis, we may perceive a day as very good or very bad based on whether we received any negative patient feedback. But when we stop and consider everything that happened, why do we allow one patient complaint to blur the many positive interactions we had with other patients? It can be more helpful to think about the shades of grey in our lives. Try to become aware of the more rational feelings and thoughts in between the extremes of black and white in our everyday lives.
  • Common negative over-generalisations are thoughts such as ‘Things always go wrong’, ‘Everyone at work is against me’, and ‘No-one understands how I feel’. These reactions are rarely helpful. Automatic generalisations may be challenged with constructive self-talk like ‘Work has been stressful for everyone recently, but I’ll try not to take things personally’, or ‘Talking to like-minded colleagues or friends will help me feel better’.
  • Mind reading involves making assumptions about what someone else thinks of us or believes about us. The evidence for such assumptions needs to be questioned, for example ‘How do I know this?’ ‘How can I be sure?’ and ‘Could my colleague have something else on their mind?’

Clinical Professor Leanne Rowe AM is a rural GP, co-author of ‘Every Doctor: healthier doctors=healthier patients’ and past Chairman of the RACGP and Deputy Chancellor of Monash University.

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