“I feel a bit tired and don’t feel in the mood for school today, Dad. I think I should be able to take a personal day.” So declared my 14-year-old daughter at breakfast the other morning. My daughter who at the time was comfortably home-schooling during our COVID-19 lockdown in Melbourne.
“Well, you won’t be able to pick and choose when you’re ‘tired’ and ‘not in the mood’ to work when you’re an adult, my love,” I replied. “Welcome to the realities of having responsibilities and building a career! You need to learn how to pick yourself up and get motivated so you can get to work, rain or shine.”
This, of course, is the Official Parental Line, enforced by my wife and I. I’m sure it sounds familiar to most of our fellow parents up and down the country. We stand by it, and we do believe there’s truth in it.
But teenagers have a remarkable knack for challenging our certainties and presuppositions. As a barrister friend of mine quipped of his own teenage daughter: “Sometimes she can pull what I thought was solid ground right out from under me. I have to leave the room to lick my wounds and come up with another line of defence. And to think I’m trained and paid to argue for a living!”
Please never admit what I’m about to say to a teenager, but could they have a point? The reality is, we all know our energy levels fluctuate day to day. Is the answer really always to battle through, shrug it off and wave away feelings of tiredness and demotivation?
One of the wonderful aspects of general practice is the degree of autonomy we have. I certainly chose family medicine rather than any other speciality to enjoy continuity of care and nurture long-term relationships with patients, along with the breadth and variety of the medicine we practise and my passion for prevention. That said, the high level of autonomy and enviable scope to choose how we live and work was another key factor in my decision. Considering this makes me wonder—could GPs better exercise this autonomy? Could we tailor our working weeks to align with, rather than fight against, our fluctuating energy levels?
In my case, for example, I know I feel charged-up and ready to go on Mondays and Tuesdays. Wednesdays and Thursdays, however, I’m in a bit of a slump. Friday mornings are ok, but by the afternoon, all I want is to finish work and start the weekend.
Similarly, I know I’m very happy working long days during the winter, but during summer there’s nothing more delightful than coming home early to potter about in the garden with an ice-cold drink in hand.
This pattern means I’m wired to work long and hard on a Monday, seeing a large volume of patients, drilling down into problems and moving adeptly to agree on management plans. My energy on a typical Monday matches that way of working. But on a Thursday, that same long routine would feel like a mountain to climb. My gut would forever be telling me to take the personal day my daughter was asking for.
A better fit for my Thursday is a series of long appointments, allowing for deeper conversations with patients. I will freely admit that I’m better dealing with patients’ mental health issues on such days. I feel less time pressure and actually really enjoy long consultations. Going with this approach longer-term, I also plan to cut my consultation hours over summer, and book in bigger days during the winter.
Perhaps practice owners might trial this approach with their own team of doctors. Even without taking energy level fluctuations into account, a more flexible approach to booking appointments allows for the fact that some GPs are very good at running to time and dealing with quick consultations, while others enjoy giving patients time to talk and explore. A flexible schedule would give these doctors the chance to really excel at complex cases and chronic disease management.
So, my teenage daughter may have a point. Rather than inadvertently forcing all doctors—irrespective of energy levels and temperament—to conform to the same vanilla format of 10-15 minute consultations every day of the week, perhaps we can each play to our strengths. Some of us may be best at running quick and efficient urgent care clinics, while others could be encouraged to run chronic disease management and mental health clinics. In both cases, we would go with the grain of our predispositions, giving more choice to patients and reducing our own work-related stress.