Too much of a good thing?

During the current crisis, online education has been invaluable, but it has also brought extra pressures

Last Tuesday evening, I had a choice between joining our local CME group online for a business meeting, followed by an educational session on adolescent mental health, or a menopause webinar resourced by the informative Dr Deirdre Lundy. I donned my blue light filter glasses and chose the menopause webinar, along with over 200 like-minded GPs.

The following evening, up to 2,000 GPs signed in to the regular ICGP webinar. Initially weekly, these webinars,following a recent survey of members, and despite large attendances, now take place fortnightly. Those who do not join can watch the recorded version at a time of their choosing. Later, that same week, the ICGP hosted a fourhour online Global Health Conference, with an interesting and relevant programme. As most GPs were in their surgeries at that time, I have no doubt that many, like myself, decided to listen in their leisure time. Online education exploded into our consciousness with the onset of the pandemic in March 2020 and has been a constant for most GPs ever since. Alongside webinars and meetings, WhatsApp groups have mushroomed for GPs with special interests. Our phones, once used for social communication and entertainment have become workstations, which we carry with
us wherever we go.

These groups were vital in the early days of the emergency that gripped the country. They provided fast evidence-based information. This was necessary as guidelines changed from one hour to the next and they are still valuable resources of ‘just-intime’ information. I am currently registered with four such groups: ‘Covid Group,’ ‘START,’ ‘Sth Tipp GP News,’ and a more recently formed group called ‘HRT Prescribers in GP’, hosted on the Telegram platform, which has over 700 members. I know that other groups exist, but I can just about manage these. Being able to post a question to a group of experienced peers, who are uncommonly generous with their time and expertise, and receive a prompt answer that helps me deliver best possible care for a patient, is a great help for my day-to-day practice. I am grateful for this technology and the shared expertise.

These groups are active day and night and while there is no need to read every post, I often find myself up to 30 minutes scanning, skimming, pinning, and starring posts that I know I will need at some
future date when I will have forgotten the details. So far, so good. But what is the effect of being ‘always on’? It takes more than blue light filter glasses to mitigate the effects of 12-to-14-hour working days. And no matter how much we try to convince ourselves that out-of-hours webinars are not work, they are certainly not leisure. Leisure, for those of us who have forgotten, is when we nourish ourselves.

It can be conversation with family or friends, listening to music, reading for the pure pleasure of the words on the page, sitting staring into space thinking about nothing or daydreaming. It can be walking, swimming, cycling, or painting. Leisure is not paying attention at meetings and webinars, even if we do this from our own fireside, kitchen table, or bed.

And what about the expert GPs who give freely of their time and expertise? Many have invested heavily in further education and training and are happy to help their colleagues free-gratis. But would we expect that same
service from any other specialist?

There is also an uneasy feeling that arises when we have not checked in for a while. What are we missing? And how do those GPs who do not participate at all feel? Are we raising the bar for all GPs, putting pressure on ourselves and others to take on more complicated cases, simply because there is no specialist service available?

(I am thinking in particular about specialist menopause clinics that I know are in the pipeline, but will probably
be confined to the Dublin area initially, leaving a lot of rural GPs, like myself, struggling alone.) The demand for
menopause expertise has escalated recently and I find myself, with the support of the group, tentatively managing cases that previously I would not have been keen to manage. I wonder at times if I am taking on too much
risk and responsibility.

I sometimes think that by engaging with this ‘always on’ culture, GPs are carrying out a major intervention on themselves. What started as a response to a crisis has become the norm. But what are we doing to our brains, our neural networks, our general health? Are we better informed, but less compassionate? Are we less present to ourselves, our families, and our patients? Is it possible to sustain this level of engagement without adequate time to recharge and recover? I do not have answers. Only time will tell.