Ten Top Tips to prevent stress and burnout in winter for family doctors.

1. Start each day thankfully and finish the day celebrating what went well. We have a tendency to remember our failings and forget those things that went well.

2. Celebrate regularly with family and friends. Plan some time together as a reward each week and especially on the darkest day of the year and at the end of each month. Consider your professional and personal web of support and increase it. Link up with other local family doctors and meet to talk and encourage each other. I have been part of a family doctor support group for 22 years now where up to ten of us will meet in one of our homes once a month then we'll discuss a clinical topic and talk to each other about our work problems. I recommend this to you.

3. Set aside time for reflection, meditation, or prayer to acknowledge your emotions about difficult patients and challenging clinical scenarios. This could take the form of a diary or reflective log as it has been shown that writing down your feelings is more effective for resolution than just thinking about them.

4. Savour every bit of positive feedback you get from your patients staff and colleagues. Put any Christmas cards and notes in a place where you can see them and read them for encouragement and write down any nice comments patients give you. Remember that you have to give it to get it so make sure that each day you encourage others to and give them some positive feedback.

5. Warmly appreciate all good turns done to you, whether it is a cup of tea and a listening ear, advice or sharing the workload.

6. Look at your boundaries and your work-life balance and think about your personal values. Consider what things are important to you? It could be wise to specifically set aside time for spiritual, religious, physical and social activities. Otherwise, medicine will take over all of these things.

7. Familiarise yourself with cognitive behavioural therapy principles which describe how I thought patterns affect our behaviours. This is psychological therapy which looks at how our feelings, thoughts and actions are linked. Having taught

about it to family doctors this year, I have learned so much about myself and am less stressed.

8. Look at some of the processes in your clinic and see what can be done to save you time especially on repetitive jobs and see how your existing staff can help you to work more efficiently. I'm thinking particularly of prescribing habits, medical note-taking, communicating with patients and running an appointment system. Developing effective team working within the practice can be very effective and supportive and it reduces stress for all parties, including patients! 9. As a family doctor in the UK, seeing patients with mental health problems is a third of my workload and developing other contacts within the community who can confidentially counsel people is a massive support to me. Just the most basic counselling takes a lot of time. Do you have a counsellor, people helpers, priests or social workers who can talk to patients who are distressed? They may need some training.

10. Education for yourself. Make a list of those areas you feel less confident about and actively look for ways of finding out more about them. This may be books and journals, discussion with colleagues or visit to a local specialist.

We wish you all a very Happy Christmas and New Year and hope that 2012 will be less stressful for you.

I was feeling especially tired yesterday when I saw my last few patients after it had been dark for hours already. I was hungry and tired. I said to my patient, a kindly 83-year-old man, “Have you had a good day?” He smiled broadly at me and chirpily replied, “Yes, doctor … and I’m still having it!” That cheered me up. Being a doctor to our patients is a privilege. Dr Ros Simpson PRIME Senior Tutor