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Navigating change
  1. Abi Berger
  1. Correspondence to Dr Abi Berger, London, UK; journal{at}

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Many people find the idea of change challenging. My personal approach to it, I recently realised, is to hang around for a long time in contemplation, feeling increasingly anxious, but then once I reach a certain point, move relatively quickly. The energy release I experience from finally waking up to wanting change is powerful, and with this surge I can make things happen.

Last October after a canny intervention from my family, I found myself suddenly ready to leave the National Health Service (NHS) GP practice I’ve been working in – wedded to, as it seemed – for 22 years. My other half suggested it might be difficult to continue working in a place where I no longer held any overall responsibility, and had to accept changes which didn’t match my values. I heard the wisdom in his words. I had long been thinking about the pros and cons and implications – but suddenly I was ready to move from ambivalence into action.

Within weeks, well before serving my notice, I had secured a new NHS part-time position. I didn’t look at adverts or send out my curriculum vitae but I did what I usually do – talked to people. In the middle of one such conversation over coffee, I was unexpectedly offered something that felt just right close to home, but far enough that my patients couldn’t follow me. They offered 15 min appointments, and would welcome me and my experience working for them just 1 day a week. I said ‘Yes’ without much hesitation.

The hardest part was not being able to enact the change for several months. Time started crawling. Waiting became excruciating. Eventually I started saying goodbye to patients, some of whom I’ve known and supported for over 20 years. It was a profoundly moving experience and was one of the few phases in my professional life where I really came to understand that I had had an impact on many people as a professional and as a person.

Now I’m safely installed elsewhere and have enjoyed a very happy fresh start. Frustrated as ever with an NHS which feels as if it is crumbling around us, I am enjoying a different patient mix, and because I’m no longer working in a place where I hold any emotional baggage, I can walk in, see the patients and go home without feeling any tugs or ties to the past. I feel lighter. My new perspective has highlighted that it was change I needed, not a complete abandonment of the NHS.

I sense that the patients I’m now meeting also appreciate the change. I’m a new face, hold no preconceived ideas about them, and they get a different experience too. I have no shorthand history with them to help me clinically, but I’m experienced enough not to have to request unnecessary tests or referrals, and not to be a pushover. I’m perhaps more alert to the unexpected, and I think this is keeping me on my toes. My weekly routines have changed little. My interest in medicine is intact and I think I have much to offer.

Looking back, I see clearly my stages of change1 – from no intention to move, through hesitation, ambivalence, anxiety, energetic action, excitement, grief and finally landing. I think it might help me to support patients make changes in their own lives. My reflections on my own experience are already informing the way I interact with patients, facilitating them I hope to tackle their own health journeys of change: whether it be deciding to stop smoking, ending a relationship, or even taking a ‘flight into health’. As I found out myself, change is often preceded by giving oneself permission to make a change.



  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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