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BT 15.000 718.042 Td /F2 21.0 Tf  [(Coping with Disaster: General Practitioners� Perspectives on )] TJ ET
BT 15.000 693.094 Td /F2 21.0 Tf  [(the Impact of the Canterbury Earthquakes)] TJ ET
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BT 15.000 675.088 Td /F3 9.8 Tf  [(April 2, 2014)] TJ ET
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BT 76.483 675.088 Td /F3 9.8 Tf  [(Research Article)] TJ ET
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BT 26.250 598.430 Td /F4 12.0 Tf  [(Abstract)] TJ ET
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BT 26.250 566.571 Td /F1 9.8 Tf  [(how these were met.)] TJ ET
BT 26.250 554.667 Td /F1 9.8 Tf  [(Methods � Qualitative study using semi-structured interviews with eight GPs from the Christchurch area exploring their )] TJ ET
BT 26.250 542.762 Td /F1 9.8 Tf  [(experiences.)] TJ ET
BT 26.250 530.857 Td /F1 9.8 Tf  [(Results � The interviews revealed that the GPs faced a range of challenges both in the immediate aftermath of the earthquakes )] TJ ET
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BT 26.250 495.143 Td /F1 9.8 Tf  [(Conclusions � All GPs reported significant increases in workload raising questions about the need for coordination of locum )] TJ ET
BT 26.250 483.238 Td /F1 9.8 Tf  [(support. GPs often found themselves working outside their area of accustomed expertise especially in relation to patients )] TJ ET
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BT 26.250 459.429 Td /F1 9.8 Tf  [(care strategies would benefit GPs responding to disasters.)] TJ ET
BT 26.250 422.826 Td /F4 12.0 Tf  [(Funding Statement)] TJ ET
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BT 26.250 294.291 Td /F1 9.8 Tf  [(showed that the first year after the disaster typically marks the peak of symptoms and mental health impacts. The majority in the )] TJ ET
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BT 81.466 270.482 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 251.077 Td /F1 9.8 Tf  [(Within New Zealand, local general practitioners \(GPs\) play a significant role in attending to the health, support and referral of )] TJ ET
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BT 26.250 598.430 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 578.476 Td /F1 9.8 Tf  [(Aim � To explore the challenges for general practitioners \(GPs\) following the 2010/2011 Canterbury earthquakes and describe )] TJ ET
BT 26.250 566.571 Td /F1 9.8 Tf  [(how these were met.)] TJ ET
BT 26.250 554.667 Td /F1 9.8 Tf  [(Methods � Qualitative study using semi-structured interviews with eight GPs from the Christchurch area exploring their )] TJ ET
BT 26.250 542.762 Td /F1 9.8 Tf  [(experiences.)] TJ ET
BT 26.250 530.857 Td /F1 9.8 Tf  [(Results � The interviews revealed that the GPs faced a range of challenges both in the immediate aftermath of the earthquakes )] TJ ET
BT 26.250 518.952 Td /F1 9.8 Tf  [(and in the following months. These included dealing with an increased and changed workload, and managing personal )] TJ ET
BT 26.250 507.048 Td /F1 9.8 Tf  [(concerns. The GPs reflected on their coping behaviour and how their professional practice had changed as a result.)] TJ ET
BT 26.250 495.143 Td /F1 9.8 Tf  [(Conclusions � All GPs reported significant increases in workload raising questions about the need for coordination of locum )] TJ ET
BT 26.250 483.238 Td /F1 9.8 Tf  [(support. GPs often found themselves working outside their area of accustomed expertise especially in relation to patients )] TJ ET
BT 26.250 471.333 Td /F1 9.8 Tf  [(needing financial aid. GPs identified a number of coping behaviours though some only in hindsight. Greater awareness of self-)] TJ ET
BT 26.250 459.429 Td /F1 9.8 Tf  [(care strategies would benefit GPs responding to disasters.)] TJ ET
BT 26.250 422.826 Td /F4 12.0 Tf  [(Funding Statement)] TJ ET
BT 26.250 402.872 Td /F1 9.8 Tf  [(This study was funded by the Massey University Research Fund. The funders had no role in study design, data collection and )] TJ ET
BT 26.250 390.967 Td /F1 9.8 Tf  [(analysis, decision to publish, or preparation of the manuscript. The authors have declared that no competing interests exist.)] TJ ET
BT 26.250 361.865 Td /F4 12.0 Tf  [(Introduction)] TJ ET
BT 26.250 341.910 Td /F1 9.8 Tf  [(Delivering best practice health services in the context of large-scale disaster events is a complex and challenging task. When a )] TJ ET
BT 26.250 330.006 Td /F1 9.8 Tf  [(disaster like an earthquake strikes, the wide-ranging physical impacts also cause social and psychological disruption at )] TJ ET
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BT 220.706 318.101 Td /F1 9.8 Tf  [( . The more extreme the hazardous conditions, the larger the social and emotional )] TJ ET
BT 26.250 306.196 Td /F1 9.8 Tf  [(effects tend to be)] TJ ET
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BT 101.052 307.703 Td /F4 8.7 Tf  [(2)] TJ ET
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BT 105.871 306.196 Td /F1 9.8 Tf  [( . Reactions to an extreme event such as a major earthquake have been found to vary. An extensive review)] TJ ET
0.267 0.267 0.267 rg
BT 568.684 307.703 Td /F4 8.7 Tf  [(3)] TJ ET
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BT 26.250 294.291 Td /F1 9.8 Tf  [(showed that the first year after the disaster typically marks the peak of symptoms and mental health impacts. The majority in the )] TJ ET
BT 26.250 282.387 Td /F1 9.8 Tf  [(community will experience some degree of emotional and psychological distress, which tends to remit over time without formal )] TJ ET
BT 26.250 270.482 Td /F1 9.8 Tf  [(intervention)] TJ ET
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0.271 0.267 0.267 rg
BT 81.466 270.482 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 251.077 Td /F1 9.8 Tf  [(Within New Zealand, local general practitioners \(GPs\) play a significant role in attending to the health, support and referral of )] TJ ET
BT 26.250 239.172 Td /F1 9.8 Tf  [(patients who have been affected by a disaster. One longitudinal study)] TJ ET
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BT 331.320 239.172 Td /F1 9.8 Tf  [( found that uninjured disaster witnesses increased their )] TJ ET
BT 26.250 227.268 Td /F1 9.8 Tf  [(number of contacts with primary care doctors by a factor of 1.55 during the first year post-disaster. GPs are well placed in the )] TJ ET
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0.271 0.267 0.267 rg
BT 541.540 215.363 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 203.458 Td /F1 9.8 Tf  [(However, GPs face the additional challenge of caring for a disaster affected community, while also being affected by the )] TJ ET
BT 26.250 191.553 Td /F1 9.8 Tf  [(disaster themselves. Local doctors may shoulder a large proportion of the burden of health, support and referral for the affected )] TJ ET
BT 26.250 179.649 Td /F1 9.8 Tf  [(population both in the post-immediate phase of a disaster and further on into the recovery. Numerous studies have shown that )] TJ ET
BT 26.250 167.744 Td /F1 9.8 Tf  [(those involved in recovery as responders can also suffer from vicarious trauma or compassion fatigue)] TJ ET
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BT 483.358 167.744 Td /F1 9.8 Tf  [( . GPs may find )] TJ ET
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0.271 0.267 0.267 rg
BT 324.175 143.934 Td /F1 9.8 Tf  [( . Previous research suggests that while 80% of primary )] TJ ET
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BT 499.846 133.537 Td /F4 8.7 Tf  [(11)] TJ ET
0.271 0.267 0.267 rg
BT 509.484 132.030 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 112.625 Td /F1 9.8 Tf  [(On 22 February 2011, Christchurch New Zealand experienced a devastating earthquake, causing extensive damage and )] TJ ET
BT 26.250 100.720 Td /F1 9.8 Tf  [(resulting in the deaths of one hundred and eighty-five people. The earthquake was part of a sequence which started in )] TJ ET
BT 26.250 88.815 Td /F1 9.8 Tf  [(September 2010 and continued with magnitude 5+ earthquakes until December 2011. However aftershocks still occur and are )] TJ ET
BT 26.250 76.911 Td /F1 9.8 Tf  [(felt throughout the region.)] TJ ET
BT 26.250 57.506 Td /F1 9.8 Tf  [(This research explores how GPs are coping with the dual challenge of personal and work demands and provides valuable )] TJ ET
BT 26.250 45.601 Td /F1 9.8 Tf  [(information to assist in future disaster education, preparation and planning resources for GPs and the local community. )] TJ ET
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BT 15.000 718.042 Td /F2 21.0 Tf  [(Coping with Disaster: General Practitioners� Perspectives on )] TJ ET
BT 15.000 693.094 Td /F2 21.0 Tf  [(the Impact of the Canterbury Earthquakes)] TJ ET
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BT 71.608 675.088 Td /F3 9.8 Tf  [(�)] TJ ET
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BT 76.483 675.088 Td /F3 9.8 Tf  [(Research Article)] TJ ET
BT 26.250 663.247 Td /F1 9.8 Tf  [(Sarb Johal)] TJ ET
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BT 72.855 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
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BT 78.276 663.247 Td /F1 9.8 Tf  [(Zoe Mounsey)] TJ ET
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BT 137.341 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
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BT 142.762 663.247 Td /F1 9.8 Tf  [(Robyn Tuohy)] TJ ET
0.271 0.267 0.267 rg
BT 200.746 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 206.167 663.247 Td /F1 9.8 Tf  [(David Johnston)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 651.342 Td /F1 9.8 Tf  [(Johal S, Mounsey Z, Tuohy R, Johnston D. Coping with Disaster: General Practitioners� Perspectives on the Impact of the )] TJ ET
BT 26.250 639.438 Td /F1 9.8 Tf  [(Canterbury Earthquakes. PLOS Currents Disasters. 2014 Apr 2 . Edition 1. doi: )] TJ ET
BT 26.250 627.533 Td /F1 9.8 Tf  [(10.1371/currents.dis.cf4c8fa61b9f4535b878c48eca87ed5d.)] TJ ET
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15.000 31.315 577.500 593.837 re W n
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BT 26.250 598.430 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 578.476 Td /F1 9.8 Tf  [(Aim � To explore the challenges for general practitioners \(GPs\) following the 2010/2011 Canterbury earthquakes and describe )] TJ ET
BT 26.250 566.571 Td /F1 9.8 Tf  [(how these were met.)] TJ ET
BT 26.250 554.667 Td /F1 9.8 Tf  [(Methods � Qualitative study using semi-structured interviews with eight GPs from the Christchurch area exploring their )] TJ ET
BT 26.250 542.762 Td /F1 9.8 Tf  [(experiences.)] TJ ET
BT 26.250 530.857 Td /F1 9.8 Tf  [(Results � The interviews revealed that the GPs faced a range of challenges both in the immediate aftermath of the earthquakes )] TJ ET
BT 26.250 518.952 Td /F1 9.8 Tf  [(and in the following months. These included dealing with an increased and changed workload, and managing personal )] TJ ET
BT 26.250 507.048 Td /F1 9.8 Tf  [(concerns. The GPs reflected on their coping behaviour and how their professional practice had changed as a result.)] TJ ET
BT 26.250 495.143 Td /F1 9.8 Tf  [(Conclusions � All GPs reported significant increases in workload raising questions about the need for coordination of locum )] TJ ET
BT 26.250 483.238 Td /F1 9.8 Tf  [(support. GPs often found themselves working outside their area of accustomed expertise especially in relation to patients )] TJ ET
BT 26.250 471.333 Td /F1 9.8 Tf  [(needing financial aid. GPs identified a number of coping behaviours though some only in hindsight. Greater awareness of self-)] TJ ET
BT 26.250 459.429 Td /F1 9.8 Tf  [(care strategies would benefit GPs responding to disasters.)] TJ ET
BT 26.250 422.826 Td /F4 12.0 Tf  [(Funding Statement)] TJ ET
BT 26.250 402.872 Td /F1 9.8 Tf  [(This study was funded by the Massey University Research Fund. The funders had no role in study design, data collection and )] TJ ET
BT 26.250 390.967 Td /F1 9.8 Tf  [(analysis, decision to publish, or preparation of the manuscript. The authors have declared that no competing interests exist.)] TJ ET
BT 26.250 361.865 Td /F4 12.0 Tf  [(Introduction)] TJ ET
BT 26.250 341.910 Td /F1 9.8 Tf  [(Delivering best practice health services in the context of large-scale disaster events is a complex and challenging task. When a )] TJ ET
BT 26.250 330.006 Td /F1 9.8 Tf  [(disaster like an earthquake strikes, the wide-ranging physical impacts also cause social and psychological disruption at )] TJ ET
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BT 26.250 227.268 Td /F1 9.8 Tf  [(number of contacts with primary care doctors by a factor of 1.55 during the first year post-disaster. GPs are well placed in the )] TJ ET
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BT 26.250 203.458 Td /F1 9.8 Tf  [(However, GPs face the additional challenge of caring for a disaster affected community, while also being affected by the )] TJ ET
BT 26.250 191.553 Td /F1 9.8 Tf  [(disaster themselves. Local doctors may shoulder a large proportion of the burden of health, support and referral for the affected )] TJ ET
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BT 26.250 155.839 Td /F1 9.8 Tf  [(themselves being positioned by the wider community as stable, responsible, influential and helpful leaders while, in reality, they )] TJ ET
BT 26.250 143.934 Td /F1 9.8 Tf  [(may be at times feeling as lost as any other survivor of the disaster)] TJ ET
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BT 26.250 112.625 Td /F1 9.8 Tf  [(On 22 February 2011, Christchurch New Zealand experienced a devastating earthquake, causing extensive damage and )] TJ ET
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BT 26.250 76.911 Td /F1 9.8 Tf  [(felt throughout the region.)] TJ ET
BT 26.250 57.506 Td /F1 9.8 Tf  [(This research explores how GPs are coping with the dual challenge of personal and work demands and provides valuable )] TJ ET
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BT 26.250 767.476 Td /F1 9.8 Tf  [(Information on GPs� experiences in this major New Zealand disaster response contributes to the on-going recovery effort and )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(preparation/planning for future events.)] TJ ET
BT 26.250 718.969 Td /F4 12.0 Tf  [(Methods)] TJ ET
BT 26.250 699.015 Td /F1 9.8 Tf  [(Qualitative research methodology was used to explore the GPs own experiences following the earthquakes. The data were )] TJ ET
BT 26.250 687.110 Td /F1 9.8 Tf  [(collected between November 2012 and February 2013. This meant that a number of months had passed since the start of the )] TJ ET
BT 26.250 675.205 Td /F1 9.8 Tf  [(earthquake sequence enabling the research to include longer term impacts and challenges. The research design used semi-)] TJ ET
BT 26.250 663.300 Td /F1 9.8 Tf  [(structured open-ended interviews to elicit extended answers to questions about the challenges GPs have faced following the )] TJ ET
BT 26.250 651.396 Td /F1 9.8 Tf  [(earthquakes. The rationale for the semi-structured interview format was to explore the perspective of each GP, using general )] TJ ET
BT 26.250 639.491 Td /F1 9.8 Tf  [(questions about what they have been experiencing since the disaster.)] TJ ET
BT 26.250 620.086 Td /F1 9.8 Tf  [(Interviews took place with eight GPs from across the Christchurch area and included practices from different socio-economic )] TJ ET
BT 26.250 608.181 Td /F1 9.8 Tf  [(areas \(poorer to more affluent suburbs\). GPs were recruited using a snowball technique in which key informants with knowledge )] TJ ET
BT 26.250 596.277 Td /F1 9.8 Tf  [(of GP services in the area nominated GPs who were then invited to participate. The interviews were scheduled at a place and )] TJ ET
BT 26.250 584.372 Td /F1 9.8 Tf  [(time convenient for each GP and audio-taped with permission from each participant. Five female GPs and three male GPs were )] TJ ET
BT 26.250 572.467 Td /F1 9.8 Tf  [(interviewed covering a range of employment types from locum and salaried GPs to practice director/owner. The length of )] TJ ET
BT 26.250 560.562 Td /F1 9.8 Tf  [(interviews ranged from 21 to 53 minutes.)] TJ ET
BT 26.250 541.158 Td /F1 9.8 Tf  [(The transcribed interviews were analysed and coded using a grounded theory approach)] TJ ET
0.267 0.267 0.267 rg
BT 405.057 542.665 Td /F4 8.7 Tf  [(15)] TJ ET
0.271 0.267 0.267 rg
BT 414.694 541.158 Td /F1 9.8 Tf  [( . These codes were used to describe )] TJ ET
BT 26.250 529.253 Td /F1 9.8 Tf  [(common themes that recurred during the interviews. Different members of the research team conducted the data collection and )] TJ ET
BT 26.250 517.348 Td /F1 9.8 Tf  [(analysis. The data went through several stages of coding and theme generation to understand what the participants saw as )] TJ ET
BT 26.250 505.443 Td /F1 9.8 Tf  [(significant and important. These themes were checked through discussions within the research team.)] TJ ET
BT 26.250 486.039 Td /F1 9.8 Tf  [(The study was peer reviewed and judged to be of low risk. This review was recorded on the Massey University Ethics )] TJ ET
BT 26.250 474.134 Td /F1 9.8 Tf  [(Committee low risk database after having met their set criteria, and participants were informed accordingly.)] TJ ET
BT 26.250 437.531 Td /F4 12.0 Tf  [(Results)] TJ ET
BT 26.250 417.577 Td /F1 9.8 Tf  [(The interviews revealed that the GPs faced a number of challenges both in the immediate aftermath of the earthquakes and in )] TJ ET
BT 26.250 405.672 Td /F1 9.8 Tf  [(the following months. Those challenges included dealing with an increased and different workload amidst managing personal )] TJ ET
BT 26.250 393.768 Td /F1 9.8 Tf  [(concerns. The GPs also reflected on their coping behaviour and how their professional practice changed as a result.)] TJ ET
BT 26.250 374.363 Td /F4 9.8 Tf  [(Impact)] TJ ET
BT 26.250 354.958 Td /F1 9.8 Tf  [(The practices experienced differing levels of impact immediately following the earthquakes from �)] TJ ET
BT 444.028 354.958 Td /F5 9.8 Tf  [(sudden, dramatic, phones )] TJ ET
BT 26.250 343.053 Td /F5 9.8 Tf  [(gone, computers gone, power�s gone, liquefaction all around us, water all around us, two or three feet)] TJ ET
BT 463.596 343.053 Td /F1 9.8 Tf  [(� to no physical or )] TJ ET
BT 26.250 331.149 Td /F1 9.8 Tf  [(structural damage. The GPs themselves experienced differing levels of personal impact:)] TJ ET
BT 26.250 311.744 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 311.744 Td /F5 9.8 Tf  [(I think it was 16 months we were out of our home�living out of a suitcase)] TJ ET
BT 347.054 311.744 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 292.339 Td /F1 9.8 Tf  [(However despite these difficulties a real sense of dedication to patients was evident in the interviews:)] TJ ET
BT 26.250 272.934 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 272.934 Td /F5 9.8 Tf  [(we went and visited people in the community that�we were worried about)] TJ ET
BT 349.755 272.934 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 253.530 Td /F1 9.8 Tf  [(One GP talked about the help they received from the local community to get the surgery running again:)] TJ ET
BT 26.250 234.125 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 234.125 Td /F5 9.8 Tf  [(people coming and going with boots, and shovels and wheelbarrows�helping to clear up)] TJ ET
BT 413.725 234.125 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 214.720 Td /F1 9.8 Tf  [(Those practices that did not experience significant structural damage due to geographical location were affected by the )] TJ ET
BT 26.250 202.815 Td /F1 9.8 Tf  [(earthquakes in other ways in particular high workload due to population migration:)] TJ ET
BT 26.250 183.411 Td /F5 9.8 Tf  [(�lots of people moved out to live with family out here� people told us their stories, but they were so relieved to be here where it )] TJ ET
BT 26.250 171.506 Td /F5 9.8 Tf  [(was safe we didn�t really have the stress of the really unwell and stressed out patients, but we had more of the stress of being )] TJ ET
BT 26.250 159.601 Td /F5 9.8 Tf  [(fully booked all the time and getting numbers through)] TJ ET
BT 255.492 159.601 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 140.196 Td /F1 9.8 Tf  [(Two of the GPs, either due to physical damage to the clinic or depopulation of the area, actually found themselves without a job:)] TJ ET
BT 26.250 120.792 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 120.792 Td /F5 9.8 Tf  [(it really affected numbers, so consequently I was laid off from work)] TJ ET
BT 316.693 120.792 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 101.387 Td /F4 9.8 Tf  [(Personal Experience)] TJ ET
BT 26.250 81.982 Td /F1 9.8 Tf  [(The GPs reflected on their experiences in the weeks following the earthquakes:)] TJ ET
BT 26.250 62.577 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 62.577 Td /F5 9.8 Tf  [(felt you had to be strong for people)] TJ ET
BT 180.173 62.577 Td /F1 9.8 Tf  [(�.)] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(2)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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15.000 96.478 577.500 680.522 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 767.476 Td /F5 9.8 Tf  [(the physical tiredness that went with the mental tiredness�just completely wiped)] TJ ET
BT 378.469 767.476 Td /F1 9.8 Tf  [( out�.)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(This �emotional exhaustion� was attributed by GPs to higher workloads and sleep deprivation due to continuing aftershocks but )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(also to the nature of the consultations:)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 716.762 Td /F5 9.8 Tf  [(my wife and I are now working standardly up to 7 o�clock at night sometimes� and a significant amount of that will be just the )] TJ ET
BT 26.250 704.857 Td /F5 9.8 Tf  [(extra component of emotion, somatic presentation)] TJ ET
BT 242.476 704.857 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 685.452 Td /F5 9.8 Tf  [(it tested the limits of your scope of practice, in a physical sense it was fine but the emotional gamut that you were having to )] TJ ET
BT 26.250 673.548 Td /F5 9.8 Tf  [(deal with)] TJ ET
BT 64.724 673.548 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(The increased demands also put stress on other practice staff, with some practices experiencing loss of front desk and nursing )] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(staff:)] TJ ET
BT 26.250 622.833 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 622.833 Td /F5 9.8 Tf  [([it has] fallen back on nursing staff quite a bit too to try and create protocols where they can up their game, unfortunately that )] TJ ET
BT 26.250 610.929 Td /F5 9.8 Tf  [(has put a lot of stress on them�)] TJ ET
BT 26.250 591.524 Td /F5 9.8 Tf  [(�we�ve had attrition rate from front desk staff�they�ve pulled out)] TJ ET
BT 302.077 591.524 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 572.119 Td /F1 9.8 Tf  [(When these GPs experienced significant increases in workloads they seemed reluctant to ask for help or felt that it was not )] TJ ET
BT 26.250 560.214 Td /F1 9.8 Tf  [(available:)] TJ ET
BT 26.250 540.810 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 540.810 Td /F5 9.8 Tf  [(there were far, far, far worse practices than us and I think, boy, they probably needed the break far more than we did)] TJ ET
BT 531.329 540.810 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 521.405 Td /F5 9.8 Tf  [(�there were no locums so we just had to cover each other�.)] TJ ET
BT 26.250 502.000 Td /F1 9.8 Tf  [(Whereas in other areas there was a perceived surfeit of support:)] TJ ET
BT 26.250 482.595 Td /F5 9.8 Tf  [(�I felt the 24 hour surgery was almost over staffed�.)] TJ ET
BT 26.250 463.191 Td /F1 9.8 Tf  [(In addition to seeing patients for stress and anxiety around the earthquakes, the GPs commented that they were often asked to )] TJ ET
BT 26.250 451.286 Td /F1 9.8 Tf  [(help with wider issues such housing and financial support:)] TJ ET
BT 26.250 431.881 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 431.881 Td /F5 9.8 Tf  [(that wasn�t so clear, the pathway to facilitating financial aid for patients)] TJ ET
BT 332.975 431.881 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 412.476 Td /F1 9.8 Tf  [(Those GPs who were well established in their communities with good networks seemed better equipped to provide wider help. )] TJ ET
BT 26.250 400.572 Td /F1 9.8 Tf  [(Others, particularly those new to areas or locums found it harder. One GP experienced difficulty working in a deprived area with )] TJ ET
BT 26.250 388.667 Td /F1 9.8 Tf  [(a high refugee population with complex inter-related needs.)] TJ ET
BT 26.250 369.262 Td /F4 9.8 Tf  [(Personal/work demands)] TJ ET
BT 26.250 349.857 Td /F1 9.8 Tf  [(The GPs talked about facing the dual challenge of personal and work demands, especially in the first few days after the )] TJ ET
BT 26.250 337.953 Td /F1 9.8 Tf  [(earthquakes. For many, this resulted in putting work first. However, one GP talked about the difficulty of putting her family first:)] TJ ET
BT 26.250 318.548 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 318.548 Td /F5 9.8 Tf  [(I was expected to go in, but I didn�t�so yeah I did feel bad about it, but my husband was so upset that he said, I can�t, you )] TJ ET
BT 26.250 306.643 Td /F5 9.8 Tf  [(can�t put your job before your family)] TJ ET
BT 180.690 306.643 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 287.238 Td /F1 9.8 Tf  [(The longer term demands, particularly working long hours, had an impact on personal relationships:)] TJ ET
BT 26.250 267.834 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 267.834 Td /F5 9.8 Tf  [(she was resentful, resentful at how much time I spent at work)] TJ ET
BT 293.400 267.834 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 248.429 Td /F1 9.8 Tf  [(Some GPs talked about how work became an escape from personal concerns:)] TJ ET
BT 26.250 229.024 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 229.024 Td /F5 9.8 Tf  [(home was more stressful than work for me)] TJ ET
BT 213.177 229.024 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 209.619 Td /F4 9.8 Tf  [(Coping behaviour)] TJ ET
BT 26.250 190.215 Td /F1 9.8 Tf  [(Some GPs were aware of the potential long term impact of this �emotional exhaustion� and ensured that they took care of )] TJ ET
BT 26.250 178.310 Td /F1 9.8 Tf  [(themselves:)] TJ ET
BT 26.250 158.905 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 158.905 Td /F5 9.8 Tf  [(I knew I needed to recharge the batteries constantly)] TJ ET
BT 253.327 158.905 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 139.500 Td /F1 9.8 Tf  [(However not all GPs were as proactive, only recognising the need for self-care in hindsight. A variety of coping behaviours were )] TJ ET
BT 26.250 127.596 Td /F1 9.8 Tf  [(identified by the GPs including peer support, exercise, socialising and taking time out. These are detailed in the table below.)] TJ ET
Q
q
15.000 96.478 577.500 680.522 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 767.476 Td /F5 9.8 Tf  [(the physical tiredness that went with the mental tiredness�just completely wiped)] TJ ET
BT 378.469 767.476 Td /F1 9.8 Tf  [( out�.)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(This �emotional exhaustion� was attributed by GPs to higher workloads and sleep deprivation due to continuing aftershocks but )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(also to the nature of the consultations:)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 716.762 Td /F5 9.8 Tf  [(my wife and I are now working standardly up to 7 o�clock at night sometimes� and a significant amount of that will be just the )] TJ ET
BT 26.250 704.857 Td /F5 9.8 Tf  [(extra component of emotion, somatic presentation)] TJ ET
BT 242.476 704.857 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 685.452 Td /F5 9.8 Tf  [(it tested the limits of your scope of practice, in a physical sense it was fine but the emotional gamut that you were having to )] TJ ET
BT 26.250 673.548 Td /F5 9.8 Tf  [(deal with)] TJ ET
BT 64.724 673.548 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(The increased demands also put stress on other practice staff, with some practices experiencing loss of front desk and nursing )] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(staff:)] TJ ET
BT 26.250 622.833 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 622.833 Td /F5 9.8 Tf  [([it has] fallen back on nursing staff quite a bit too to try and create protocols where they can up their game, unfortunately that )] TJ ET
BT 26.250 610.929 Td /F5 9.8 Tf  [(has put a lot of stress on them�)] TJ ET
BT 26.250 591.524 Td /F5 9.8 Tf  [(�we�ve had attrition rate from front desk staff�they�ve pulled out)] TJ ET
BT 302.077 591.524 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 572.119 Td /F1 9.8 Tf  [(When these GPs experienced significant increases in workloads they seemed reluctant to ask for help or felt that it was not )] TJ ET
BT 26.250 560.214 Td /F1 9.8 Tf  [(available:)] TJ ET
BT 26.250 540.810 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 540.810 Td /F5 9.8 Tf  [(there were far, far, far worse practices than us and I think, boy, they probably needed the break far more than we did)] TJ ET
BT 531.329 540.810 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 521.405 Td /F5 9.8 Tf  [(�there were no locums so we just had to cover each other�.)] TJ ET
BT 26.250 502.000 Td /F1 9.8 Tf  [(Whereas in other areas there was a perceived surfeit of support:)] TJ ET
BT 26.250 482.595 Td /F5 9.8 Tf  [(�I felt the 24 hour surgery was almost over staffed�.)] TJ ET
BT 26.250 463.191 Td /F1 9.8 Tf  [(In addition to seeing patients for stress and anxiety around the earthquakes, the GPs commented that they were often asked to )] TJ ET
BT 26.250 451.286 Td /F1 9.8 Tf  [(help with wider issues such housing and financial support:)] TJ ET
BT 26.250 431.881 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 431.881 Td /F5 9.8 Tf  [(that wasn�t so clear, the pathway to facilitating financial aid for patients)] TJ ET
BT 332.975 431.881 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 412.476 Td /F1 9.8 Tf  [(Those GPs who were well established in their communities with good networks seemed better equipped to provide wider help. )] TJ ET
BT 26.250 400.572 Td /F1 9.8 Tf  [(Others, particularly those new to areas or locums found it harder. One GP experienced difficulty working in a deprived area with )] TJ ET
BT 26.250 388.667 Td /F1 9.8 Tf  [(a high refugee population with complex inter-related needs.)] TJ ET
BT 26.250 369.262 Td /F4 9.8 Tf  [(Personal/work demands)] TJ ET
BT 26.250 349.857 Td /F1 9.8 Tf  [(The GPs talked about facing the dual challenge of personal and work demands, especially in the first few days after the )] TJ ET
BT 26.250 337.953 Td /F1 9.8 Tf  [(earthquakes. For many, this resulted in putting work first. However, one GP talked about the difficulty of putting her family first:)] TJ ET
BT 26.250 318.548 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 318.548 Td /F5 9.8 Tf  [(I was expected to go in, but I didn�t�so yeah I did feel bad about it, but my husband was so upset that he said, I can�t, you )] TJ ET
BT 26.250 306.643 Td /F5 9.8 Tf  [(can�t put your job before your family)] TJ ET
BT 180.690 306.643 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 287.238 Td /F1 9.8 Tf  [(The longer term demands, particularly working long hours, had an impact on personal relationships:)] TJ ET
BT 26.250 267.834 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 267.834 Td /F5 9.8 Tf  [(she was resentful, resentful at how much time I spent at work)] TJ ET
BT 293.400 267.834 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 248.429 Td /F1 9.8 Tf  [(Some GPs talked about how work became an escape from personal concerns:)] TJ ET
BT 26.250 229.024 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 229.024 Td /F5 9.8 Tf  [(home was more stressful than work for me)] TJ ET
BT 213.177 229.024 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 209.619 Td /F4 9.8 Tf  [(Coping behaviour)] TJ ET
BT 26.250 190.215 Td /F1 9.8 Tf  [(Some GPs were aware of the potential long term impact of this �emotional exhaustion� and ensured that they took care of )] TJ ET
BT 26.250 178.310 Td /F1 9.8 Tf  [(themselves:)] TJ ET
BT 26.250 158.905 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 158.905 Td /F5 9.8 Tf  [(I knew I needed to recharge the batteries constantly)] TJ ET
BT 253.327 158.905 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 139.500 Td /F1 9.8 Tf  [(However not all GPs were as proactive, only recognising the need for self-care in hindsight. A variety of coping behaviours were )] TJ ET
BT 26.250 127.596 Td /F1 9.8 Tf  [(identified by the GPs including peer support, exercise, socialising and taking time out. These are detailed in the table below.)] TJ ET
Q
q
15.000 96.478 577.500 680.522 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 767.476 Td /F5 9.8 Tf  [(the physical tiredness that went with the mental tiredness�just completely wiped)] TJ ET
BT 378.469 767.476 Td /F1 9.8 Tf  [( out�.)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(This �emotional exhaustion� was attributed by GPs to higher workloads and sleep deprivation due to continuing aftershocks but )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(also to the nature of the consultations:)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 716.762 Td /F5 9.8 Tf  [(my wife and I are now working standardly up to 7 o�clock at night sometimes� and a significant amount of that will be just the )] TJ ET
BT 26.250 704.857 Td /F5 9.8 Tf  [(extra component of emotion, somatic presentation)] TJ ET
BT 242.476 704.857 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 685.452 Td /F5 9.8 Tf  [(it tested the limits of your scope of practice, in a physical sense it was fine but the emotional gamut that you were having to )] TJ ET
BT 26.250 673.548 Td /F5 9.8 Tf  [(deal with)] TJ ET
BT 64.724 673.548 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(The increased demands also put stress on other practice staff, with some practices experiencing loss of front desk and nursing )] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(staff:)] TJ ET
BT 26.250 622.833 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 622.833 Td /F5 9.8 Tf  [([it has] fallen back on nursing staff quite a bit too to try and create protocols where they can up their game, unfortunately that )] TJ ET
BT 26.250 610.929 Td /F5 9.8 Tf  [(has put a lot of stress on them�)] TJ ET
BT 26.250 591.524 Td /F5 9.8 Tf  [(�we�ve had attrition rate from front desk staff�they�ve pulled out)] TJ ET
BT 302.077 591.524 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 572.119 Td /F1 9.8 Tf  [(When these GPs experienced significant increases in workloads they seemed reluctant to ask for help or felt that it was not )] TJ ET
BT 26.250 560.214 Td /F1 9.8 Tf  [(available:)] TJ ET
BT 26.250 540.810 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 540.810 Td /F5 9.8 Tf  [(there were far, far, far worse practices than us and I think, boy, they probably needed the break far more than we did)] TJ ET
BT 531.329 540.810 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 521.405 Td /F5 9.8 Tf  [(�there were no locums so we just had to cover each other�.)] TJ ET
BT 26.250 502.000 Td /F1 9.8 Tf  [(Whereas in other areas there was a perceived surfeit of support:)] TJ ET
BT 26.250 482.595 Td /F5 9.8 Tf  [(�I felt the 24 hour surgery was almost over staffed�.)] TJ ET
BT 26.250 463.191 Td /F1 9.8 Tf  [(In addition to seeing patients for stress and anxiety around the earthquakes, the GPs commented that they were often asked to )] TJ ET
BT 26.250 451.286 Td /F1 9.8 Tf  [(help with wider issues such housing and financial support:)] TJ ET
BT 26.250 431.881 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 431.881 Td /F5 9.8 Tf  [(that wasn�t so clear, the pathway to facilitating financial aid for patients)] TJ ET
BT 332.975 431.881 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 412.476 Td /F1 9.8 Tf  [(Those GPs who were well established in their communities with good networks seemed better equipped to provide wider help. )] TJ ET
BT 26.250 400.572 Td /F1 9.8 Tf  [(Others, particularly those new to areas or locums found it harder. One GP experienced difficulty working in a deprived area with )] TJ ET
BT 26.250 388.667 Td /F1 9.8 Tf  [(a high refugee population with complex inter-related needs.)] TJ ET
BT 26.250 369.262 Td /F4 9.8 Tf  [(Personal/work demands)] TJ ET
BT 26.250 349.857 Td /F1 9.8 Tf  [(The GPs talked about facing the dual challenge of personal and work demands, especially in the first few days after the )] TJ ET
BT 26.250 337.953 Td /F1 9.8 Tf  [(earthquakes. For many, this resulted in putting work first. However, one GP talked about the difficulty of putting her family first:)] TJ ET
BT 26.250 318.548 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 318.548 Td /F5 9.8 Tf  [(I was expected to go in, but I didn�t�so yeah I did feel bad about it, but my husband was so upset that he said, I can�t, you )] TJ ET
BT 26.250 306.643 Td /F5 9.8 Tf  [(can�t put your job before your family)] TJ ET
BT 180.690 306.643 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 287.238 Td /F1 9.8 Tf  [(The longer term demands, particularly working long hours, had an impact on personal relationships:)] TJ ET
BT 26.250 267.834 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 267.834 Td /F5 9.8 Tf  [(she was resentful, resentful at how much time I spent at work)] TJ ET
BT 293.400 267.834 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 248.429 Td /F1 9.8 Tf  [(Some GPs talked about how work became an escape from personal concerns:)] TJ ET
BT 26.250 229.024 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 229.024 Td /F5 9.8 Tf  [(home was more stressful than work for me)] TJ ET
BT 213.177 229.024 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 209.619 Td /F4 9.8 Tf  [(Coping behaviour)] TJ ET
BT 26.250 190.215 Td /F1 9.8 Tf  [(Some GPs were aware of the potential long term impact of this �emotional exhaustion� and ensured that they took care of )] TJ ET
BT 26.250 178.310 Td /F1 9.8 Tf  [(themselves:)] TJ ET
BT 26.250 158.905 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 158.905 Td /F5 9.8 Tf  [(I knew I needed to recharge the batteries constantly)] TJ ET
BT 253.327 158.905 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 139.500 Td /F1 9.8 Tf  [(However not all GPs were as proactive, only recognising the need for self-care in hindsight. A variety of coping behaviours were )] TJ ET
BT 26.250 127.596 Td /F1 9.8 Tf  [(identified by the GPs including peer support, exercise, socialising and taking time out. These are detailed in the table below.)] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(3)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

Q
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0.271 0.267 0.267 rg
q
15.000 28.126 577.500 748.874 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 1. Types of coping behaviour reported by GPs, and frequency of endorsement)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 517.649 555.000 238.115 re f
0.965 0.965 0.965 rg
27.000 742.734 327.509 12.280 re f
0.267 0.267 0.267 rg
26.625 754.639 327.884 0.750 re f
26.625 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 745.490 Td /F4 9.8 Tf  [(Coping Behaviour)] TJ ET
0.965 0.965 0.965 rg
354.509 742.734 225.991 12.280 re f
0.267 0.267 0.267 rg
354.509 754.639 226.366 0.750 re f
580.125 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 359.009 745.490 Td /F4 9.8 Tf  [(Number of GPs endorsing)] TJ ET
0.267 0.267 0.267 rg
26.625 742.359 328.259 0.750 re f
26.625 676.837 0.750 66.272 re f
0.271 0.267 0.267 rg
BT 31.875 732.504 Td /F1 9.8 Tf  [(Getting away from Christchurch)] TJ ET
0.267 0.267 0.267 rg
354.134 742.359 226.741 0.750 re f
354.134 676.837 0.750 66.272 re f
580.125 676.837 0.750 66.272 re f
0.271 0.267 0.267 rg
BT 359.384 732.504 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 676.837 328.259 0.750 re f
26.625 660.955 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 666.982 Td /F1 9.8 Tf  [(Informal peer / colleague support)] TJ ET
0.267 0.267 0.267 rg
354.134 676.837 226.741 0.750 re f
354.134 660.955 0.750 16.631 re f
580.125 660.955 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 666.982 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 660.955 328.259 0.750 re f
26.625 645.074 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 651.100 Td /F1 9.8 Tf  [(Socialising with friends)] TJ ET
0.267 0.267 0.267 rg
354.134 660.955 226.741 0.750 re f
354.134 645.074 0.750 16.631 re f
580.125 645.074 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 651.100 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 645.074 328.259 0.750 re f
26.625 629.193 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 635.219 Td /F1 9.8 Tf  [(Work as an escape from personal difficulties)] TJ ET
0.267 0.267 0.267 rg
354.134 645.074 226.741 0.750 re f
354.134 629.193 0.750 16.631 re f
580.125 629.193 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 635.219 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 629.193 328.259 0.750 re f
26.625 613.312 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 619.338 Td /F1 9.8 Tf  [(Exercise)] TJ ET
0.267 0.267 0.267 rg
354.134 629.193 226.741 0.750 re f
354.134 613.312 0.750 16.631 re f
580.125 613.312 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 619.338 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 613.312 328.259 0.750 re f
26.625 597.430 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 603.457 Td /F1 9.8 Tf  [(Working part-time / reducing hours)] TJ ET
0.267 0.267 0.267 rg
354.134 613.312 226.741 0.750 re f
354.134 597.430 0.750 16.631 re f
580.125 597.430 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 603.457 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 597.430 328.259 0.750 re f
26.625 581.549 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 587.575 Td /F1 9.8 Tf  [(TV / Games / Hobbies)] TJ ET
0.267 0.267 0.267 rg
354.134 597.430 226.741 0.750 re f
354.134 581.549 0.750 16.631 re f
580.125 581.549 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 587.575 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 581.549 328.259 0.750 re f
26.625 565.668 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 571.694 Td /F1 9.8 Tf  [(Personal faith / Church)] TJ ET
0.267 0.267 0.267 rg
354.134 581.549 226.741 0.750 re f
354.134 565.668 0.750 16.631 re f
580.125 565.668 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 571.694 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 565.668 328.259 0.750 re f
26.625 549.787 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 555.813 Td /F1 9.8 Tf  [(Community support)] TJ ET
0.267 0.267 0.267 rg
354.134 565.668 226.741 0.750 re f
354.134 549.787 0.750 16.631 re f
580.125 549.787 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 555.813 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 549.787 328.259 0.750 re f
26.625 533.905 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 539.932 Td /F1 9.8 Tf  [(Formal peer support)] TJ ET
0.267 0.267 0.267 rg
354.134 549.787 226.741 0.750 re f
354.134 533.905 0.750 16.631 re f
580.125 533.905 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 539.932 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 533.905 328.259 0.750 re f
26.625 518.024 328.259 0.750 re f
26.625 518.024 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 524.050 Td /F1 9.8 Tf  [(Focusing on others)] TJ ET
0.267 0.267 0.267 rg
354.134 533.905 226.741 0.750 re f
354.134 518.024 226.741 0.750 re f
354.134 518.024 0.750 16.631 re f
580.125 518.024 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 524.050 Td /F1 9.8 Tf  [(1)] TJ ET
BT 26.250 463.125 Td /F1 9.8 Tf  [(Five of the GPs commented on the importance of getting away:)] TJ ET
BT 26.250 443.721 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 443.721 Td /F5 9.8 Tf  [(you need to get away from it and you probably don�t realise until you get away from it how stressful it is being here)] TJ ET
BT 521.014 443.721 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 424.316 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 424.316 Td /F5 9.8 Tf  [(it was amazing just totally switch off, totally relax and yeah the contrast as soon as I came back to Christchurch, like within 24 )] TJ ET
BT 26.250 412.411 Td /F5 9.8 Tf  [(hours my stress levels were back up again)] TJ ET
BT 209.940 412.411 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 393.006 Td /F1 9.8 Tf  [(GPs commented that peer support was beneficial both informally within the practice � �)] TJ ET
BT 400.153 393.006 Td /F5 9.8 Tf  [(we actually met, had lunch together)] TJ ET
BT 553.520 393.006 Td /F1 9.8 Tf  [(� and )] TJ ET
BT 26.250 381.102 Td /F1 9.8 Tf  [(formally from the wider profession � �)] TJ ET
BT 186.628 381.102 Td /F5 9.8 Tf  [(being able to mix with colleagues and talk about it)] TJ ET
BT 401.235 381.102 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 361.697 Td /F1 9.8 Tf  [(Physical activity was used by several GPs:)] TJ ET
BT 26.250 342.292 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 342.292 Td /F5 9.8 Tf  [(managed to keep up exercise which is incredibly important)] TJ ET
BT 282.012 342.292 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 322.887 Td /F1 9.8 Tf  [(Socialising and keeping up existing networks was seen as important especially where, due to housing damage, people were )] TJ ET
BT 26.250 310.983 Td /F1 9.8 Tf  [(living in temporary accommodation:)] TJ ET
BT 26.250 291.578 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 291.578 Td /F5 9.8 Tf  [(go out for dinner, made sure I saw friends)] TJ ET
BT 209.413 291.578 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 272.173 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 272.173 Td /F5 9.8 Tf  [(a network of friendships that we had with the church)] TJ ET
BT 253.854 272.173 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 252.768 Td /F1 9.8 Tf  [(Four GPs talked about how work became an escape from personal concerns:)] TJ ET
BT 26.250 233.364 Td /F1 9.8 Tf  [(�home was more stressful than work for me�)] TJ ET
BT 26.250 213.959 Td /F1 9.8 Tf  [(One of the GPs who worked part-time felt that time away from the surgery helped them to recoup their energy and focus:)] TJ ET
BT 26.250 194.554 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 194.554 Td /F5 9.8 Tf  [(we all work part-time and that for most of us is to make sure we don�t get burnt out)] TJ ET
BT 383.900 194.554 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 175.149 Td /F1 9.8 Tf  [(One GP had reduced his surgery hours so that he could better cope with the workload and avoid burnout.)] TJ ET
BT 26.250 155.745 Td /F1 9.8 Tf  [(Two of the GPs mentioned empathy exhaustion or compassion fatigue � �)] TJ ET
BT 343.817 155.745 Td /F5 9.8 Tf  [(you are unable to sustain that level of empathy with )] TJ ET
BT 26.250 143.840 Td /F5 9.8 Tf  [(people all of the time)] TJ ET
BT 116.213 143.840 Td /F1 9.8 Tf  [(� and time away was seen as beneficial to maintain compassion.)] TJ ET
BT 26.250 124.435 Td /F1 9.8 Tf  [(None of the GPs indicated that they had sought any professional help with dealing with the additional stress though one )] TJ ET
BT 26.250 112.530 Td /F1 9.8 Tf  [(suggested that it might have been helpful:)] TJ ET
BT 26.250 93.126 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 93.126 Td /F5 9.8 Tf  [(I didn�t actually, probably again, certainly on reflection a case could have been made for that)] TJ ET
BT 426.741 93.126 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 73.721 Td /F4 9.8 Tf  [(Professional practice)] TJ ET
BT 26.250 54.316 Td /F1 9.8 Tf  [(Generally, the GPs commented on how the experience had changed their professional practice. Some of these changes were )] TJ ET
BT 26.250 42.411 Td /F1 9.8 Tf  [(practical in nature, e.g. ensuring that everyone had each others� contact details. Others focused on behaviour, with one GP )] TJ ET
Q
q
15.000 28.126 577.500 748.874 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 1. Types of coping behaviour reported by GPs, and frequency of endorsement)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 517.649 555.000 238.115 re f
0.965 0.965 0.965 rg
27.000 742.734 327.509 12.280 re f
0.267 0.267 0.267 rg
26.625 754.639 327.884 0.750 re f
26.625 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 745.490 Td /F4 9.8 Tf  [(Coping Behaviour)] TJ ET
0.965 0.965 0.965 rg
354.509 742.734 225.991 12.280 re f
0.267 0.267 0.267 rg
354.509 754.639 226.366 0.750 re f
580.125 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 359.009 745.490 Td /F4 9.8 Tf  [(Number of GPs endorsing)] TJ ET
0.267 0.267 0.267 rg
26.625 742.359 328.259 0.750 re f
26.625 676.837 0.750 66.272 re f
0.271 0.267 0.267 rg
BT 31.875 732.504 Td /F1 9.8 Tf  [(Getting away from Christchurch)] TJ ET
0.267 0.267 0.267 rg
354.134 742.359 226.741 0.750 re f
354.134 676.837 0.750 66.272 re f
580.125 676.837 0.750 66.272 re f
0.271 0.267 0.267 rg
BT 359.384 732.504 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 676.837 328.259 0.750 re f
26.625 660.955 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 666.982 Td /F1 9.8 Tf  [(Informal peer / colleague support)] TJ ET
0.267 0.267 0.267 rg
354.134 676.837 226.741 0.750 re f
354.134 660.955 0.750 16.631 re f
580.125 660.955 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 666.982 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 660.955 328.259 0.750 re f
26.625 645.074 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 651.100 Td /F1 9.8 Tf  [(Socialising with friends)] TJ ET
0.267 0.267 0.267 rg
354.134 660.955 226.741 0.750 re f
354.134 645.074 0.750 16.631 re f
580.125 645.074 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 651.100 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 645.074 328.259 0.750 re f
26.625 629.193 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 635.219 Td /F1 9.8 Tf  [(Work as an escape from personal difficulties)] TJ ET
0.267 0.267 0.267 rg
354.134 645.074 226.741 0.750 re f
354.134 629.193 0.750 16.631 re f
580.125 629.193 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 635.219 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 629.193 328.259 0.750 re f
26.625 613.312 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 619.338 Td /F1 9.8 Tf  [(Exercise)] TJ ET
0.267 0.267 0.267 rg
354.134 629.193 226.741 0.750 re f
354.134 613.312 0.750 16.631 re f
580.125 613.312 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 619.338 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 613.312 328.259 0.750 re f
26.625 597.430 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 603.457 Td /F1 9.8 Tf  [(Working part-time / reducing hours)] TJ ET
0.267 0.267 0.267 rg
354.134 613.312 226.741 0.750 re f
354.134 597.430 0.750 16.631 re f
580.125 597.430 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 603.457 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 597.430 328.259 0.750 re f
26.625 581.549 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 587.575 Td /F1 9.8 Tf  [(TV / Games / Hobbies)] TJ ET
0.267 0.267 0.267 rg
354.134 597.430 226.741 0.750 re f
354.134 581.549 0.750 16.631 re f
580.125 581.549 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 587.575 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 581.549 328.259 0.750 re f
26.625 565.668 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 571.694 Td /F1 9.8 Tf  [(Personal faith / Church)] TJ ET
0.267 0.267 0.267 rg
354.134 581.549 226.741 0.750 re f
354.134 565.668 0.750 16.631 re f
580.125 565.668 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 571.694 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 565.668 328.259 0.750 re f
26.625 549.787 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 555.813 Td /F1 9.8 Tf  [(Community support)] TJ ET
0.267 0.267 0.267 rg
354.134 565.668 226.741 0.750 re f
354.134 549.787 0.750 16.631 re f
580.125 549.787 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 555.813 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 549.787 328.259 0.750 re f
26.625 533.905 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 539.932 Td /F1 9.8 Tf  [(Formal peer support)] TJ ET
0.267 0.267 0.267 rg
354.134 549.787 226.741 0.750 re f
354.134 533.905 0.750 16.631 re f
580.125 533.905 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 539.932 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 533.905 328.259 0.750 re f
26.625 518.024 328.259 0.750 re f
26.625 518.024 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 524.050 Td /F1 9.8 Tf  [(Focusing on others)] TJ ET
0.267 0.267 0.267 rg
354.134 533.905 226.741 0.750 re f
354.134 518.024 226.741 0.750 re f
354.134 518.024 0.750 16.631 re f
580.125 518.024 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 524.050 Td /F1 9.8 Tf  [(1)] TJ ET
BT 26.250 463.125 Td /F1 9.8 Tf  [(Five of the GPs commented on the importance of getting away:)] TJ ET
BT 26.250 443.721 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 443.721 Td /F5 9.8 Tf  [(you need to get away from it and you probably don�t realise until you get away from it how stressful it is being here)] TJ ET
BT 521.014 443.721 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 424.316 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 424.316 Td /F5 9.8 Tf  [(it was amazing just totally switch off, totally relax and yeah the contrast as soon as I came back to Christchurch, like within 24 )] TJ ET
BT 26.250 412.411 Td /F5 9.8 Tf  [(hours my stress levels were back up again)] TJ ET
BT 209.940 412.411 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 393.006 Td /F1 9.8 Tf  [(GPs commented that peer support was beneficial both informally within the practice � �)] TJ ET
BT 400.153 393.006 Td /F5 9.8 Tf  [(we actually met, had lunch together)] TJ ET
BT 553.520 393.006 Td /F1 9.8 Tf  [(� and )] TJ ET
BT 26.250 381.102 Td /F1 9.8 Tf  [(formally from the wider profession � �)] TJ ET
BT 186.628 381.102 Td /F5 9.8 Tf  [(being able to mix with colleagues and talk about it)] TJ ET
BT 401.235 381.102 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 361.697 Td /F1 9.8 Tf  [(Physical activity was used by several GPs:)] TJ ET
BT 26.250 342.292 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 342.292 Td /F5 9.8 Tf  [(managed to keep up exercise which is incredibly important)] TJ ET
BT 282.012 342.292 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 322.887 Td /F1 9.8 Tf  [(Socialising and keeping up existing networks was seen as important especially where, due to housing damage, people were )] TJ ET
BT 26.250 310.983 Td /F1 9.8 Tf  [(living in temporary accommodation:)] TJ ET
BT 26.250 291.578 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 291.578 Td /F5 9.8 Tf  [(go out for dinner, made sure I saw friends)] TJ ET
BT 209.413 291.578 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 272.173 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 272.173 Td /F5 9.8 Tf  [(a network of friendships that we had with the church)] TJ ET
BT 253.854 272.173 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 252.768 Td /F1 9.8 Tf  [(Four GPs talked about how work became an escape from personal concerns:)] TJ ET
BT 26.250 233.364 Td /F1 9.8 Tf  [(�home was more stressful than work for me�)] TJ ET
BT 26.250 213.959 Td /F1 9.8 Tf  [(One of the GPs who worked part-time felt that time away from the surgery helped them to recoup their energy and focus:)] TJ ET
BT 26.250 194.554 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 194.554 Td /F5 9.8 Tf  [(we all work part-time and that for most of us is to make sure we don�t get burnt out)] TJ ET
BT 383.900 194.554 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 175.149 Td /F1 9.8 Tf  [(One GP had reduced his surgery hours so that he could better cope with the workload and avoid burnout.)] TJ ET
BT 26.250 155.745 Td /F1 9.8 Tf  [(Two of the GPs mentioned empathy exhaustion or compassion fatigue � �)] TJ ET
BT 343.817 155.745 Td /F5 9.8 Tf  [(you are unable to sustain that level of empathy with )] TJ ET
BT 26.250 143.840 Td /F5 9.8 Tf  [(people all of the time)] TJ ET
BT 116.213 143.840 Td /F1 9.8 Tf  [(� and time away was seen as beneficial to maintain compassion.)] TJ ET
BT 26.250 124.435 Td /F1 9.8 Tf  [(None of the GPs indicated that they had sought any professional help with dealing with the additional stress though one )] TJ ET
BT 26.250 112.530 Td /F1 9.8 Tf  [(suggested that it might have been helpful:)] TJ ET
BT 26.250 93.126 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 93.126 Td /F5 9.8 Tf  [(I didn�t actually, probably again, certainly on reflection a case could have been made for that)] TJ ET
BT 426.741 93.126 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 73.721 Td /F4 9.8 Tf  [(Professional practice)] TJ ET
BT 26.250 54.316 Td /F1 9.8 Tf  [(Generally, the GPs commented on how the experience had changed their professional practice. Some of these changes were )] TJ ET
BT 26.250 42.411 Td /F1 9.8 Tf  [(practical in nature, e.g. ensuring that everyone had each others� contact details. Others focused on behaviour, with one GP )] TJ ET
Q
q
15.000 28.126 577.500 748.874 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 1. Types of coping behaviour reported by GPs, and frequency of endorsement)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 517.649 555.000 238.115 re f
0.965 0.965 0.965 rg
27.000 742.734 327.509 12.280 re f
0.267 0.267 0.267 rg
26.625 754.639 327.884 0.750 re f
26.625 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 745.490 Td /F4 9.8 Tf  [(Coping Behaviour)] TJ ET
0.965 0.965 0.965 rg
354.509 742.734 225.991 12.280 re f
0.267 0.267 0.267 rg
354.509 754.639 226.366 0.750 re f
580.125 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 359.009 745.490 Td /F4 9.8 Tf  [(Number of GPs endorsing)] TJ ET
0.267 0.267 0.267 rg
26.625 742.359 328.259 0.750 re f
26.625 676.837 0.750 66.272 re f
0.271 0.267 0.267 rg
BT 31.875 732.504 Td /F1 9.8 Tf  [(Getting away from Christchurch)] TJ ET
0.267 0.267 0.267 rg
354.134 742.359 226.741 0.750 re f
354.134 676.837 0.750 66.272 re f
580.125 676.837 0.750 66.272 re f
0.271 0.267 0.267 rg
BT 359.384 732.504 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 676.837 328.259 0.750 re f
26.625 660.955 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 666.982 Td /F1 9.8 Tf  [(Informal peer / colleague support)] TJ ET
0.267 0.267 0.267 rg
354.134 676.837 226.741 0.750 re f
354.134 660.955 0.750 16.631 re f
580.125 660.955 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 666.982 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 660.955 328.259 0.750 re f
26.625 645.074 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 651.100 Td /F1 9.8 Tf  [(Socialising with friends)] TJ ET
0.267 0.267 0.267 rg
354.134 660.955 226.741 0.750 re f
354.134 645.074 0.750 16.631 re f
580.125 645.074 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 651.100 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
26.625 645.074 328.259 0.750 re f
26.625 629.193 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 635.219 Td /F1 9.8 Tf  [(Work as an escape from personal difficulties)] TJ ET
0.267 0.267 0.267 rg
354.134 645.074 226.741 0.750 re f
354.134 629.193 0.750 16.631 re f
580.125 629.193 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 635.219 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
26.625 629.193 328.259 0.750 re f
26.625 613.312 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 619.338 Td /F1 9.8 Tf  [(Exercise)] TJ ET
0.267 0.267 0.267 rg
354.134 629.193 226.741 0.750 re f
354.134 613.312 0.750 16.631 re f
580.125 613.312 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 619.338 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 613.312 328.259 0.750 re f
26.625 597.430 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 603.457 Td /F1 9.8 Tf  [(Working part-time / reducing hours)] TJ ET
0.267 0.267 0.267 rg
354.134 613.312 226.741 0.750 re f
354.134 597.430 0.750 16.631 re f
580.125 597.430 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 603.457 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 597.430 328.259 0.750 re f
26.625 581.549 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 587.575 Td /F1 9.8 Tf  [(TV / Games / Hobbies)] TJ ET
0.267 0.267 0.267 rg
354.134 597.430 226.741 0.750 re f
354.134 581.549 0.750 16.631 re f
580.125 581.549 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 587.575 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 581.549 328.259 0.750 re f
26.625 565.668 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 571.694 Td /F1 9.8 Tf  [(Personal faith / Church)] TJ ET
0.267 0.267 0.267 rg
354.134 581.549 226.741 0.750 re f
354.134 565.668 0.750 16.631 re f
580.125 565.668 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 571.694 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 565.668 328.259 0.750 re f
26.625 549.787 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 555.813 Td /F1 9.8 Tf  [(Community support)] TJ ET
0.267 0.267 0.267 rg
354.134 565.668 226.741 0.750 re f
354.134 549.787 0.750 16.631 re f
580.125 549.787 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 555.813 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 549.787 328.259 0.750 re f
26.625 533.905 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 539.932 Td /F1 9.8 Tf  [(Formal peer support)] TJ ET
0.267 0.267 0.267 rg
354.134 549.787 226.741 0.750 re f
354.134 533.905 0.750 16.631 re f
580.125 533.905 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 539.932 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 533.905 328.259 0.750 re f
26.625 518.024 328.259 0.750 re f
26.625 518.024 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 524.050 Td /F1 9.8 Tf  [(Focusing on others)] TJ ET
0.267 0.267 0.267 rg
354.134 533.905 226.741 0.750 re f
354.134 518.024 226.741 0.750 re f
354.134 518.024 0.750 16.631 re f
580.125 518.024 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 359.384 524.050 Td /F1 9.8 Tf  [(1)] TJ ET
BT 26.250 463.125 Td /F1 9.8 Tf  [(Five of the GPs commented on the importance of getting away:)] TJ ET
BT 26.250 443.721 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 443.721 Td /F5 9.8 Tf  [(you need to get away from it and you probably don�t realise until you get away from it how stressful it is being here)] TJ ET
BT 521.014 443.721 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 424.316 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 424.316 Td /F5 9.8 Tf  [(it was amazing just totally switch off, totally relax and yeah the contrast as soon as I came back to Christchurch, like within 24 )] TJ ET
BT 26.250 412.411 Td /F5 9.8 Tf  [(hours my stress levels were back up again)] TJ ET
BT 209.940 412.411 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 393.006 Td /F1 9.8 Tf  [(GPs commented that peer support was beneficial both informally within the practice � �)] TJ ET
BT 400.153 393.006 Td /F5 9.8 Tf  [(we actually met, had lunch together)] TJ ET
BT 553.520 393.006 Td /F1 9.8 Tf  [(� and )] TJ ET
BT 26.250 381.102 Td /F1 9.8 Tf  [(formally from the wider profession � �)] TJ ET
BT 186.628 381.102 Td /F5 9.8 Tf  [(being able to mix with colleagues and talk about it)] TJ ET
BT 401.235 381.102 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 361.697 Td /F1 9.8 Tf  [(Physical activity was used by several GPs:)] TJ ET
BT 26.250 342.292 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 342.292 Td /F5 9.8 Tf  [(managed to keep up exercise which is incredibly important)] TJ ET
BT 282.012 342.292 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 322.887 Td /F1 9.8 Tf  [(Socialising and keeping up existing networks was seen as important especially where, due to housing damage, people were )] TJ ET
BT 26.250 310.983 Td /F1 9.8 Tf  [(living in temporary accommodation:)] TJ ET
BT 26.250 291.578 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 291.578 Td /F5 9.8 Tf  [(go out for dinner, made sure I saw friends)] TJ ET
BT 209.413 291.578 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 272.173 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 272.173 Td /F5 9.8 Tf  [(a network of friendships that we had with the church)] TJ ET
BT 253.854 272.173 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 252.768 Td /F1 9.8 Tf  [(Four GPs talked about how work became an escape from personal concerns:)] TJ ET
BT 26.250 233.364 Td /F1 9.8 Tf  [(�home was more stressful than work for me�)] TJ ET
BT 26.250 213.959 Td /F1 9.8 Tf  [(One of the GPs who worked part-time felt that time away from the surgery helped them to recoup their energy and focus:)] TJ ET
BT 26.250 194.554 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 194.554 Td /F5 9.8 Tf  [(we all work part-time and that for most of us is to make sure we don�t get burnt out)] TJ ET
BT 383.900 194.554 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 175.149 Td /F1 9.8 Tf  [(One GP had reduced his surgery hours so that he could better cope with the workload and avoid burnout.)] TJ ET
BT 26.250 155.745 Td /F1 9.8 Tf  [(Two of the GPs mentioned empathy exhaustion or compassion fatigue � �)] TJ ET
BT 343.817 155.745 Td /F5 9.8 Tf  [(you are unable to sustain that level of empathy with )] TJ ET
BT 26.250 143.840 Td /F5 9.8 Tf  [(people all of the time)] TJ ET
BT 116.213 143.840 Td /F1 9.8 Tf  [(� and time away was seen as beneficial to maintain compassion.)] TJ ET
BT 26.250 124.435 Td /F1 9.8 Tf  [(None of the GPs indicated that they had sought any professional help with dealing with the additional stress though one )] TJ ET
BT 26.250 112.530 Td /F1 9.8 Tf  [(suggested that it might have been helpful:)] TJ ET
BT 26.250 93.126 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 93.126 Td /F5 9.8 Tf  [(I didn�t actually, probably again, certainly on reflection a case could have been made for that)] TJ ET
BT 426.741 93.126 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 73.721 Td /F4 9.8 Tf  [(Professional practice)] TJ ET
BT 26.250 54.316 Td /F1 9.8 Tf  [(Generally, the GPs commented on how the experience had changed their professional practice. Some of these changes were )] TJ ET
BT 26.250 42.411 Td /F1 9.8 Tf  [(practical in nature, e.g. ensuring that everyone had each others� contact details. Others focused on behaviour, with one GP )] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(4)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

Q
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0.271 0.267 0.267 rg
q
15.000 34.017 577.500 742.983 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(talking about the ease of communicating with patients:)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 748.071 Td /F5 9.8 Tf  [(more empathic�there is a bit of a common bond when people go through similar experiences like that)] TJ ET
BT 470.060 748.071 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(A clear benefit to GPs was the ability to offer patients extended consultations to discuss concerns arising from the earthquakes )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(as well as being able to refer patients to free counselling services:)] TJ ET
BT 26.250 697.357 Td /F5 9.8 Tf  [(�we had counsellors here that we had sitting here�just having cups of tea with people and being available�.)] TJ ET
BT 26.250 677.952 Td /F1 9.8 Tf  [(The GPs commented on the support that they received both from Pegasus \(primary healthcare organisation\) such as water )] TJ ET
BT 26.250 666.048 Td /F1 9.8 Tf  [(supplies and the District Health Board \(DHB\) in the form of information:)] TJ ET
BT 26.250 646.643 Td /F5 9.8 Tf  [(�the DHB were absolutely great in getting out information to us very quickly�.)] TJ ET
BT 26.250 627.238 Td /F1 9.8 Tf  [(One of the GPs also commented on how open patients had become, for example talking about drinking and smoking )] TJ ET
BT 26.250 615.333 Td /F1 9.8 Tf  [(behaviours � �)] TJ ET
BT 88.026 615.333 Td /F5 9.8 Tf  [(I am just surprised at how frank people are and it really makes my job easier)] TJ ET
BT 416.942 615.333 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 595.929 Td /F1 9.8 Tf  [(The earthquakes raised issues about disaster preparedness, for example an inability to remain in contact with colleagues, and )] TJ ET
BT 26.250 584.024 Td /F1 9.8 Tf  [(business continuity for the GP practices. However, GPs reported having more supplies in stock after the earthquakes and more )] TJ ET
BT 26.250 572.119 Td /F1 9.8 Tf  [(comprehensive emergency plans in place)] TJ ET
BT 205.611 572.119 Td /F5 9.8 Tf  [(.)] TJ ET
BT 26.250 535.517 Td /F4 12.0 Tf  [(Discussion)] TJ ET
BT 26.250 515.562 Td /F1 9.8 Tf  [(In line with previous research, this study demonstrates that GPs played a major role in attending to the health and wider support )] TJ ET
BT 26.250 503.658 Td /F1 9.8 Tf  [(needs of affected populations during and after the Canterbury earthquakes of 2010-11.)] TJ ET
q
26.250 480.040 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 482.788 Td /F1 9.8 Tf  [(Table 2. Lessons Offered)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 291.993 555.000 180.547 re f
0.267 0.267 0.267 rg
26.625 471.415 554.250 0.750 re f
26.625 435.606 0.750 36.559 re f
580.125 435.606 0.750 36.559 re f
0.271 0.267 0.267 rg
0.271 0.267 0.267 RG
45.962 464.859 m 
45.962 465.306 45.779 465.750 45.463 466.066 c
45.147 466.382 44.703 466.565 44.256 466.565 c
43.810 466.565 43.366 466.382 43.050 466.066 c
42.734 465.750 42.550 465.306 42.550 464.859 c
42.550 464.413 42.734 463.969 43.050 463.653 c
43.366 463.337 43.810 463.153 44.256 463.153 c
44.703 463.153 45.147 463.337 45.463 463.653 c
45.779 463.969 45.962 464.413 45.962 464.859 c f
BT 51.375 461.892 Td /F1 9.8 Tf  [(GPs played a major role in attending to the health and wider support needs of affected populations during the )] TJ ET
BT 524.513 461.892 Td /F1 9.8 Tf  [(Canterbury )] TJ ET
BT 51.375 449.987 Td /F1 9.8 Tf  [(earthquake sequence, often working outside their area of accustomed expertise.)] TJ ET
0.267 0.267 0.267 rg
26.625 435.606 554.250 0.750 re f
26.625 399.796 0.750 36.559 re f
580.125 399.796 0.750 36.559 re f
0.271 0.267 0.267 rg
45.962 429.050 m 
45.962 429.496 45.779 429.940 45.463 430.256 c
45.147 430.572 44.703 430.756 44.256 430.756 c
43.810 430.756 43.366 430.572 43.050 430.256 c
42.734 429.940 42.550 429.496 42.550 429.050 c
42.550 428.603 42.734 428.159 43.050 427.843 c
43.366 427.527 43.810 427.343 44.256 427.343 c
44.703 427.343 45.147 427.527 45.463 427.843 c
45.779 428.159 45.962 428.603 45.962 429.050 c f
BT 51.375 426.082 Td /F1 9.8 Tf  [(All GPs reported significantly increased workloads in the disaster response phase, and through into the recovery period, )] TJ ET
BT 51.375 414.177 Td /F1 9.8 Tf  [(resulting in increased mental and physical fatigue.)] TJ ET
0.267 0.267 0.267 rg
26.625 399.796 554.250 0.750 re f
26.625 363.987 0.750 36.559 re f
580.125 363.987 0.750 36.559 re f
0.271 0.267 0.267 rg
45.962 393.240 m 
45.962 393.687 45.779 394.131 45.463 394.447 c
45.147 394.763 44.703 394.946 44.256 394.946 c
43.810 394.946 43.366 394.763 43.050 394.447 c
42.734 394.131 42.550 393.687 42.550 393.240 c
42.550 392.794 42.734 392.350 43.050 392.034 c
43.366 391.718 43.810 391.534 44.256 391.534 c
44.703 391.534 45.147 391.718 45.463 392.034 c
45.779 392.350 45.962 392.794 45.962 393.240 c f
BT 51.375 390.273 Td /F1 9.8 Tf  [(There was a high level of awareness of the risk of compassion fatigue and burnout and a high need for self-care, but )] TJ ET
BT 555.382 390.273 Td /F1 9.8 Tf  [(this )] TJ ET
BT 51.375 378.368 Td /F1 9.8 Tf  [(was difficult to balance against increased community needs during the disaster.)] TJ ET
0.267 0.267 0.267 rg
26.625 363.987 554.250 0.750 re f
26.625 328.177 0.750 36.559 re f
580.125 328.177 0.750 36.559 re f
0.271 0.267 0.267 rg
45.962 357.431 m 
45.962 357.877 45.779 358.321 45.463 358.637 c
45.147 358.953 44.703 359.137 44.256 359.137 c
43.810 359.137 43.366 358.953 43.050 358.637 c
42.734 358.321 42.550 357.877 42.550 357.431 c
42.550 356.984 42.734 356.540 43.050 356.224 c
43.366 355.908 43.810 355.724 44.256 355.724 c
44.703 355.724 45.147 355.908 45.463 356.224 c
45.779 356.540 45.962 356.984 45.962 357.431 c f
BT 51.375 354.463 Td /F1 9.8 Tf  [(A number of effective coping strategies were reported, including time away from the affected disaster area, informal )] TJ ET
BT 551.004 354.463 Td /F1 9.8 Tf  [(peer )] TJ ET
BT 51.375 342.558 Td /F1 9.8 Tf  [(and colleague support, and spending time with friends.)] TJ ET
0.267 0.267 0.267 rg
26.625 328.177 554.250 0.750 re f
26.625 292.368 554.250 0.750 re f
26.625 292.368 0.750 36.559 re f
580.125 292.368 0.750 36.559 re f
0.271 0.267 0.267 rg
45.962 321.621 m 
45.962 322.068 45.779 322.512 45.463 322.828 c
45.147 323.144 44.703 323.327 44.256 323.327 c
43.810 323.327 43.366 323.144 43.050 322.828 c
42.734 322.512 42.550 322.068 42.550 321.621 c
42.550 321.175 42.734 320.731 43.050 320.415 c
43.366 320.099 43.810 319.915 44.256 319.915 c
44.703 319.915 45.147 320.099 45.463 320.415 c
45.779 320.731 45.962 321.175 45.962 321.621 c f
BT 51.375 318.654 Td /F1 9.8 Tf  [(An identified gap concerning the coordination and provision of extra staff resource for affected practices \(e.g. locum )] TJ ET
BT 51.375 306.749 Td /F1 9.8 Tf  [(support\) may be exacerbated by reluctance on the part of GPs to ask for assistance.)] TJ ET
BT 26.250 237.469 Td /F1 9.8 Tf  [(The impact of the disaster manifested itself in different ways. For some, the effects were focused on the physical infrastructure )] TJ ET
BT 26.250 225.564 Td /F1 9.8 Tf  [(of the practice. For others, this affected the type and volume of workload that the practice experienced, and the staff available to )] TJ ET
BT 26.250 213.660 Td /F1 9.8 Tf  [(deal with them. It is worth noting that GPs also commented on how their helping relationship with the community they served )] TJ ET
BT 26.250 201.755 Td /F1 9.8 Tf  [(was not uni-directional. GPs talked about how community members helped them get their practices up and running again during )] TJ ET
BT 26.250 189.850 Td /F1 9.8 Tf  [(the first hours and days after the earthquakes.)] TJ ET
BT 26.250 170.445 Td /F1 9.8 Tf  [(Despite the challenges it was clear that GPs were committed to helping their patients to the best of their abilities. While )] TJ ET
BT 26.250 158.541 Td /F1 9.8 Tf  [(attempting to provide health services to their affected communities, GPs reflected that they experienced significant mental and )] TJ ET
BT 26.250 146.636 Td /F1 9.8 Tf  [(physical fatigue. This speaks to the issue identified previously)] TJ ET
0.267 0.267 0.267 rg
BT 291.781 148.143 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 301.419 146.636 Td /F1 9.8 Tf  [( ; even though they were affected, GPs may feel a responsibility )] TJ ET
BT 26.250 134.731 Td /F1 9.8 Tf  [(to provide stable, responsible and helpful leadership post-disaster.)] TJ ET
Q
q
15.000 34.017 577.500 742.983 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(talking about the ease of communicating with patients:)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 748.071 Td /F5 9.8 Tf  [(more empathic�there is a bit of a common bond when people go through similar experiences like that)] TJ ET
BT 470.060 748.071 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(A clear benefit to GPs was the ability to offer patients extended consultations to discuss concerns arising from the earthquakes )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(as well as being able to refer patients to free counselling services:)] TJ ET
BT 26.250 697.357 Td /F5 9.8 Tf  [(�we had counsellors here that we had sitting here�just having cups of tea with people and being available�.)] TJ ET
BT 26.250 677.952 Td /F1 9.8 Tf  [(The GPs commented on the support that they received both from Pegasus \(primary healthcare organisation\) such as water )] TJ ET
BT 26.250 666.048 Td /F1 9.8 Tf  [(supplies and the District Health Board \(DHB\) in the form of information:)] TJ ET
BT 26.250 646.643 Td /F5 9.8 Tf  [(�the DHB were absolutely great in getting out information to us very quickly�.)] TJ ET
BT 26.250 627.238 Td /F1 9.8 Tf  [(One of the GPs also commented on how open patients had become, for example talking about drinking and smoking )] TJ ET
BT 26.250 615.333 Td /F1 9.8 Tf  [(behaviours � �)] TJ ET
BT 88.026 615.333 Td /F5 9.8 Tf  [(I am just surprised at how frank people are and it really makes my job easier)] TJ ET
BT 416.942 615.333 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 595.929 Td /F1 9.8 Tf  [(The earthquakes raised issues about disaster preparedness, for example an inability to remain in contact with colleagues, and )] TJ ET
BT 26.250 584.024 Td /F1 9.8 Tf  [(business continuity for the GP practices. However, GPs reported having more supplies in stock after the earthquakes and more )] TJ ET
BT 26.250 572.119 Td /F1 9.8 Tf  [(comprehensive emergency plans in place)] TJ ET
BT 205.611 572.119 Td /F5 9.8 Tf  [(.)] TJ ET
BT 26.250 535.517 Td /F4 12.0 Tf  [(Discussion)] TJ ET
BT 26.250 515.562 Td /F1 9.8 Tf  [(In line with previous research, this study demonstrates that GPs played a major role in attending to the health and wider support )] TJ ET
BT 26.250 503.658 Td /F1 9.8 Tf  [(needs of affected populations during and after the Canterbury earthquakes of 2010-11.)] TJ ET
q
26.250 480.040 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 482.788 Td /F1 9.8 Tf  [(Table 2. Lessons Offered)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 291.993 555.000 180.547 re f
0.267 0.267 0.267 rg
26.625 471.415 554.250 0.750 re f
26.625 435.606 0.750 36.559 re f
580.125 435.606 0.750 36.559 re f
0.271 0.267 0.267 rg
0.271 0.267 0.267 RG
45.962 464.859 m 
45.962 465.306 45.779 465.750 45.463 466.066 c
45.147 466.382 44.703 466.565 44.256 466.565 c
43.810 466.565 43.366 466.382 43.050 466.066 c
42.734 465.750 42.550 465.306 42.550 464.859 c
42.550 464.413 42.734 463.969 43.050 463.653 c
43.366 463.337 43.810 463.153 44.256 463.153 c
44.703 463.153 45.147 463.337 45.463 463.653 c
45.779 463.969 45.962 464.413 45.962 464.859 c f
BT 51.375 461.892 Td /F1 9.8 Tf  [(GPs played a major role in attending to the health and wider support needs of affected populations during the )] TJ ET
BT 524.513 461.892 Td /F1 9.8 Tf  [(Canterbury )] TJ ET
BT 51.375 449.987 Td /F1 9.8 Tf  [(earthquake sequence, often working outside their area of accustomed expertise.)] TJ ET
0.267 0.267 0.267 rg
26.625 435.606 554.250 0.750 re f
26.625 399.796 0.750 36.559 re f
580.125 399.796 0.750 36.559 re f
0.271 0.267 0.267 rg
45.962 429.050 m 
45.962 429.496 45.779 429.940 45.463 430.256 c
45.147 430.572 44.703 430.756 44.256 430.756 c
43.810 430.756 43.366 430.572 43.050 430.256 c
42.734 429.940 42.550 429.496 42.550 429.050 c
42.550 428.603 42.734 428.159 43.050 427.843 c
43.366 427.527 43.810 427.343 44.256 427.343 c
44.703 427.343 45.147 427.527 45.463 427.843 c
45.779 428.159 45.962 428.603 45.962 429.050 c f
BT 51.375 426.082 Td /F1 9.8 Tf  [(All GPs reported significantly increased workloads in the disaster response phase, and through into the recovery period, )] TJ ET
BT 51.375 414.177 Td /F1 9.8 Tf  [(resulting in increased mental and physical fatigue.)] TJ ET
0.267 0.267 0.267 rg
26.625 399.796 554.250 0.750 re f
26.625 363.987 0.750 36.559 re f
580.125 363.987 0.750 36.559 re f
0.271 0.267 0.267 rg
45.962 393.240 m 
45.962 393.687 45.779 394.131 45.463 394.447 c
45.147 394.763 44.703 394.946 44.256 394.946 c
43.810 394.946 43.366 394.763 43.050 394.447 c
42.734 394.131 42.550 393.687 42.550 393.240 c
42.550 392.794 42.734 392.350 43.050 392.034 c
43.366 391.718 43.810 391.534 44.256 391.534 c
44.703 391.534 45.147 391.718 45.463 392.034 c
45.779 392.350 45.962 392.794 45.962 393.240 c f
BT 51.375 390.273 Td /F1 9.8 Tf  [(There was a high level of awareness of the risk of compassion fatigue and burnout and a high need for self-care, but )] TJ ET
BT 555.382 390.273 Td /F1 9.8 Tf  [(this )] TJ ET
BT 51.375 378.368 Td /F1 9.8 Tf  [(was difficult to balance against increased community needs during the disaster.)] TJ ET
0.267 0.267 0.267 rg
26.625 363.987 554.250 0.750 re f
26.625 328.177 0.750 36.559 re f
580.125 328.177 0.750 36.559 re f
0.271 0.267 0.267 rg
45.962 357.431 m 
45.962 357.877 45.779 358.321 45.463 358.637 c
45.147 358.953 44.703 359.137 44.256 359.137 c
43.810 359.137 43.366 358.953 43.050 358.637 c
42.734 358.321 42.550 357.877 42.550 357.431 c
42.550 356.984 42.734 356.540 43.050 356.224 c
43.366 355.908 43.810 355.724 44.256 355.724 c
44.703 355.724 45.147 355.908 45.463 356.224 c
45.779 356.540 45.962 356.984 45.962 357.431 c f
BT 51.375 354.463 Td /F1 9.8 Tf  [(A number of effective coping strategies were reported, including time away from the affected disaster area, informal )] TJ ET
BT 551.004 354.463 Td /F1 9.8 Tf  [(peer )] TJ ET
BT 51.375 342.558 Td /F1 9.8 Tf  [(and colleague support, and spending time with friends.)] TJ ET
0.267 0.267 0.267 rg
26.625 328.177 554.250 0.750 re f
26.625 292.368 554.250 0.750 re f
26.625 292.368 0.750 36.559 re f
580.125 292.368 0.750 36.559 re f
0.271 0.267 0.267 rg
45.962 321.621 m 
45.962 322.068 45.779 322.512 45.463 322.828 c
45.147 323.144 44.703 323.327 44.256 323.327 c
43.810 323.327 43.366 323.144 43.050 322.828 c
42.734 322.512 42.550 322.068 42.550 321.621 c
42.550 321.175 42.734 320.731 43.050 320.415 c
43.366 320.099 43.810 319.915 44.256 319.915 c
44.703 319.915 45.147 320.099 45.463 320.415 c
45.779 320.731 45.962 321.175 45.962 321.621 c f
BT 51.375 318.654 Td /F1 9.8 Tf  [(An identified gap concerning the coordination and provision of extra staff resource for affected practices \(e.g. locum )] TJ ET
BT 51.375 306.749 Td /F1 9.8 Tf  [(support\) may be exacerbated by reluctance on the part of GPs to ask for assistance.)] TJ ET
BT 26.250 237.469 Td /F1 9.8 Tf  [(The impact of the disaster manifested itself in different ways. For some, the effects were focused on the physical infrastructure )] TJ ET
BT 26.250 225.564 Td /F1 9.8 Tf  [(of the practice. For others, this affected the type and volume of workload that the practice experienced, and the staff available to )] TJ ET
BT 26.250 213.660 Td /F1 9.8 Tf  [(deal with them. It is worth noting that GPs also commented on how their helping relationship with the community they served )] TJ ET
BT 26.250 201.755 Td /F1 9.8 Tf  [(was not uni-directional. GPs talked about how community members helped them get their practices up and running again during )] TJ ET
BT 26.250 189.850 Td /F1 9.8 Tf  [(the first hours and days after the earthquakes.)] TJ ET
BT 26.250 170.445 Td /F1 9.8 Tf  [(Despite the challenges it was clear that GPs were committed to helping their patients to the best of their abilities. While )] TJ ET
BT 26.250 158.541 Td /F1 9.8 Tf  [(attempting to provide health services to their affected communities, GPs reflected that they experienced significant mental and )] TJ ET
BT 26.250 146.636 Td /F1 9.8 Tf  [(physical fatigue. This speaks to the issue identified previously)] TJ ET
0.267 0.267 0.267 rg
BT 291.781 148.143 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 301.419 146.636 Td /F1 9.8 Tf  [( ; even though they were affected, GPs may feel a responsibility )] TJ ET
BT 26.250 134.731 Td /F1 9.8 Tf  [(to provide stable, responsible and helpful leadership post-disaster.)] TJ ET
Q
q
15.000 34.017 577.500 742.983 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(talking about the ease of communicating with patients:)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(�)] TJ ET
BT 29.497 748.071 Td /F5 9.8 Tf  [(more empathic�there is a bit of a common bond when people go through similar experiences like that)] TJ ET
BT 470.060 748.071 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(A clear benefit to GPs was the ability to offer patients extended consultations to discuss concerns arising from the earthquakes )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(as well as being able to refer patients to free counselling services:)] TJ ET
BT 26.250 697.357 Td /F5 9.8 Tf  [(�we had counsellors here that we had sitting here�just having cups of tea with people and being available�.)] TJ ET
BT 26.250 677.952 Td /F1 9.8 Tf  [(The GPs commented on the support that they received both from Pegasus \(primary healthcare organisation\) such as water )] TJ ET
BT 26.250 666.048 Td /F1 9.8 Tf  [(supplies and the District Health Board \(DHB\) in the form of information:)] TJ ET
BT 26.250 646.643 Td /F5 9.8 Tf  [(�the DHB were absolutely great in getting out information to us very quickly�.)] TJ ET
BT 26.250 627.238 Td /F1 9.8 Tf  [(One of the GPs also commented on how open patients had become, for example talking about drinking and smoking )] TJ ET
BT 26.250 615.333 Td /F1 9.8 Tf  [(behaviours � �)] TJ ET
BT 88.026 615.333 Td /F5 9.8 Tf  [(I am just surprised at how frank people are and it really makes my job easier)] TJ ET
BT 416.942 615.333 Td /F1 9.8 Tf  [(�.)] TJ ET
BT 26.250 595.929 Td /F1 9.8 Tf  [(The earthquakes raised issues about disaster preparedness, for example an inability to remain in contact with colleagues, and )] TJ ET
BT 26.250 584.024 Td /F1 9.8 Tf  [(business continuity for the GP practices. However, GPs reported having more supplies in stock after the earthquakes and more )] TJ ET
BT 26.250 572.119 Td /F1 9.8 Tf  [(comprehensive emergency plans in place)] TJ ET
BT 205.611 572.119 Td /F5 9.8 Tf  [(.)] TJ ET
BT 26.250 535.517 Td /F4 12.0 Tf  [(Discussion)] TJ ET
BT 26.250 515.562 Td /F1 9.8 Tf  [(In line with previous research, this study demonstrates that GPs played a major role in attending to the health and wider support )] TJ ET
BT 26.250 503.658 Td /F1 9.8 Tf  [(needs of affected populations during and after the Canterbury earthquakes of 2010-11.)] TJ ET
q
26.250 480.040 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 482.788 Td /F1 9.8 Tf  [(Table 2. Lessons Offered)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 291.993 555.000 180.547 re f
0.267 0.267 0.267 rg
26.625 471.415 554.250 0.750 re f
26.625 435.606 0.750 36.559 re f
580.125 435.606 0.750 36.559 re f
0.271 0.267 0.267 rg
0.271 0.267 0.267 RG
45.962 464.859 m 
45.962 465.306 45.779 465.750 45.463 466.066 c
45.147 466.382 44.703 466.565 44.256 466.565 c
43.810 466.565 43.366 466.382 43.050 466.066 c
42.734 465.750 42.550 465.306 42.550 464.859 c
42.550 464.413 42.734 463.969 43.050 463.653 c
43.366 463.337 43.810 463.153 44.256 463.153 c
44.703 463.153 45.147 463.337 45.463 463.653 c
45.779 463.969 45.962 464.413 45.962 464.859 c f
BT 51.375 461.892 Td /F1 9.8 Tf  [(GPs played a major role in attending to the health and wider support needs of affected populations during the )] TJ ET
BT 524.513 461.892 Td /F1 9.8 Tf  [(Canterbury )] TJ ET
BT 51.375 449.987 Td /F1 9.8 Tf  [(earthquake sequence, often working outside their area of accustomed expertise.)] TJ ET
0.267 0.267 0.267 rg
26.625 435.606 554.250 0.750 re f
26.625 399.796 0.750 36.559 re f
580.125 399.796 0.750 36.559 re f
0.271 0.267 0.267 rg
45.962 429.050 m 
45.962 429.496 45.779 429.940 45.463 430.256 c
45.147 430.572 44.703 430.756 44.256 430.756 c
43.810 430.756 43.366 430.572 43.050 430.256 c
42.734 429.940 42.550 429.496 42.550 429.050 c
42.550 428.603 42.734 428.159 43.050 427.843 c
43.366 427.527 43.810 427.343 44.256 427.343 c
44.703 427.343 45.147 427.527 45.463 427.843 c
45.779 428.159 45.962 428.603 45.962 429.050 c f
BT 51.375 426.082 Td /F1 9.8 Tf  [(All GPs reported significantly increased workloads in the disaster response phase, and through into the recovery period, )] TJ ET
BT 51.375 414.177 Td /F1 9.8 Tf  [(resulting in increased mental and physical fatigue.)] TJ ET
0.267 0.267 0.267 rg
26.625 399.796 554.250 0.750 re f
26.625 363.987 0.750 36.559 re f
580.125 363.987 0.750 36.559 re f
0.271 0.267 0.267 rg
45.962 393.240 m 
45.962 393.687 45.779 394.131 45.463 394.447 c
45.147 394.763 44.703 394.946 44.256 394.946 c
43.810 394.946 43.366 394.763 43.050 394.447 c
42.734 394.131 42.550 393.687 42.550 393.240 c
42.550 392.794 42.734 392.350 43.050 392.034 c
43.366 391.718 43.810 391.534 44.256 391.534 c
44.703 391.534 45.147 391.718 45.463 392.034 c
45.779 392.350 45.962 392.794 45.962 393.240 c f
BT 51.375 390.273 Td /F1 9.8 Tf  [(There was a high level of awareness of the risk of compassion fatigue and burnout and a high need for self-care, but )] TJ ET
BT 555.382 390.273 Td /F1 9.8 Tf  [(this )] TJ ET
BT 51.375 378.368 Td /F1 9.8 Tf  [(was difficult to balance against increased community needs during the disaster.)] TJ ET
0.267 0.267 0.267 rg
26.625 363.987 554.250 0.750 re f
26.625 328.177 0.750 36.559 re f
580.125 328.177 0.750 36.559 re f
0.271 0.267 0.267 rg
45.962 357.431 m 
45.962 357.877 45.779 358.321 45.463 358.637 c
45.147 358.953 44.703 359.137 44.256 359.137 c
43.810 359.137 43.366 358.953 43.050 358.637 c
42.734 358.321 42.550 357.877 42.550 357.431 c
42.550 356.984 42.734 356.540 43.050 356.224 c
43.366 355.908 43.810 355.724 44.256 355.724 c
44.703 355.724 45.147 355.908 45.463 356.224 c
45.779 356.540 45.962 356.984 45.962 357.431 c f
BT 51.375 354.463 Td /F1 9.8 Tf  [(A number of effective coping strategies were reported, including time away from the affected disaster area, informal )] TJ ET
BT 551.004 354.463 Td /F1 9.8 Tf  [(peer )] TJ ET
BT 51.375 342.558 Td /F1 9.8 Tf  [(and colleague support, and spending time with friends.)] TJ ET
0.267 0.267 0.267 rg
26.625 328.177 554.250 0.750 re f
26.625 292.368 554.250 0.750 re f
26.625 292.368 0.750 36.559 re f
580.125 292.368 0.750 36.559 re f
0.271 0.267 0.267 rg
45.962 321.621 m 
45.962 322.068 45.779 322.512 45.463 322.828 c
45.147 323.144 44.703 323.327 44.256 323.327 c
43.810 323.327 43.366 323.144 43.050 322.828 c
42.734 322.512 42.550 322.068 42.550 321.621 c
42.550 321.175 42.734 320.731 43.050 320.415 c
43.366 320.099 43.810 319.915 44.256 319.915 c
44.703 319.915 45.147 320.099 45.463 320.415 c
45.779 320.731 45.962 321.175 45.962 321.621 c f
BT 51.375 318.654 Td /F1 9.8 Tf  [(An identified gap concerning the coordination and provision of extra staff resource for affected practices \(e.g. locum )] TJ ET
BT 51.375 306.749 Td /F1 9.8 Tf  [(support\) may be exacerbated by reluctance on the part of GPs to ask for assistance.)] TJ ET
BT 26.250 237.469 Td /F1 9.8 Tf  [(The impact of the disaster manifested itself in different ways. For some, the effects were focused on the physical infrastructure )] TJ ET
BT 26.250 225.564 Td /F1 9.8 Tf  [(of the practice. For others, this affected the type and volume of workload that the practice experienced, and the staff available to )] TJ ET
BT 26.250 213.660 Td /F1 9.8 Tf  [(deal with them. It is worth noting that GPs also commented on how their helping relationship with the community they served )] TJ ET
BT 26.250 201.755 Td /F1 9.8 Tf  [(was not uni-directional. GPs talked about how community members helped them get their practices up and running again during )] TJ ET
BT 26.250 189.850 Td /F1 9.8 Tf  [(the first hours and days after the earthquakes.)] TJ ET
BT 26.250 170.445 Td /F1 9.8 Tf  [(Despite the challenges it was clear that GPs were committed to helping their patients to the best of their abilities. While )] TJ ET
BT 26.250 158.541 Td /F1 9.8 Tf  [(attempting to provide health services to their affected communities, GPs reflected that they experienced significant mental and )] TJ ET
BT 26.250 146.636 Td /F1 9.8 Tf  [(physical fatigue. This speaks to the issue identified previously)] TJ ET
0.267 0.267 0.267 rg
BT 291.781 148.143 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 301.419 146.636 Td /F1 9.8 Tf  [( ; even though they were affected, GPs may feel a responsibility )] TJ ET
BT 26.250 134.731 Td /F1 9.8 Tf  [(to provide stable, responsible and helpful leadership post-disaster.)] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(5)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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0.271 0.267 0.267 rg
0.271 0.267 0.267 RG
q
15.000 32.458 577.500 744.542 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(The recent patient experience report in New Zealand)] TJ ET
0.267 0.267 0.267 rg
BT 253.854 768.983 Td /F4 8.7 Tf  [(12)] TJ ET
0.271 0.267 0.267 rg
BT 263.491 767.476 Td /F1 9.8 Tf  [( showed that 84 per cent of adults surveyed expressed confidence and )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(trust in their GP. Although this is advantageous in terms of building and maintaining the doctor-patient relationship, especially in )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(times of great strain and community uncertainty, it also perhaps places an additional burden on GPs in a disaster. The )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(confidence and trust that patients had in their doctors and their shared experience through the earthquakes may help to explain )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(the increased openness described by some of the GPs regarding patient health-related behaviours. Although this frankness is )] TJ ET
BT 26.250 707.952 Td /F1 9.8 Tf  [(to be encouraged, care needs to be taken to ensure that GPs have the knowledge and referral pathways available to them if )] TJ ET
BT 26.250 696.048 Td /F1 9.8 Tf  [(they perceive that short-term coping behaviours risk turning into potential health hazards.)] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(GPs also talked about threats to their income through employment displacement, and the consequent disruption and uncertainty )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(in other aspects of their lives that this brings. Furthermore, some GPs talked about dilemmas where the careful negotiated )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(balance between personal and professional life was highlighted for them. Some GPs found the structure and role of the )] TJ ET
BT 26.250 640.929 Td /F1 9.8 Tf  [(professional role less stressful than their personal lives. However, immersement in their professional role may come at some )] TJ ET
BT 26.250 629.024 Td /F1 9.8 Tf  [(personal cost as the recovery draws on.)] TJ ET
BT 26.250 609.619 Td /F1 9.8 Tf  [(In guarding against the risks of vicarious trauma and compassion fatigue, it is important that GPs have good awareness of self-)] TJ ET
BT 26.250 597.714 Td /F1 9.8 Tf  [(care and practices approporiate to sustain themselves through a disaster. GPs showed an appreciation of how they may be )] TJ ET
BT 26.250 585.810 Td /F1 9.8 Tf  [(personally affected by the earthquakes, although this was talked about when reflecting on their experiences rather than at the )] TJ ET
BT 26.250 573.905 Td /F1 9.8 Tf  [(time they were going through the response and early-recovery period. One account focusing on disaster recovery leadership )] TJ ET
BT 26.250 562.000 Td /F1 9.8 Tf  [(and leaders)] TJ ET
0.267 0.267 0.267 rg
BT 77.194 563.507 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 86.831 562.000 Td /F1 9.8 Tf  [( states that, �)] TJ ET
BT 143.196 562.000 Td /F5 9.8 Tf  [(they can face burn out at the same time the needs of the community are at their peak� )] TJ ET
BT 516.055 562.000 Td /F1 9.8 Tf  [(\(p.30\). The )] TJ ET
BT 26.250 550.095 Td /F1 9.8 Tf  [(GPs have a leadership role within their communities and as such it is important that they, �)] TJ ET
BT 415.324 550.095 Td /F5 9.8 Tf  [(have a �self-care� plan that outlines )] TJ ET
BT 26.250 538.191 Td /F5 9.8 Tf  [(routines and activities that support health, relationships and allots time for pleasure and leisure)] TJ ET
BT 433.771 538.191 Td /F1 9.8 Tf  [(� \(McNaughton, 2013, p.31\))] TJ ET
0.267 0.267 0.267 rg
BT 552.994 539.698 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 562.631 538.191 Td /F1 9.8 Tf  [( . )] TJ ET
BT 26.250 526.286 Td /F1 9.8 Tf  [(Some GPs had consciously identified a need for self-care whereas others identified beneficial behaviours only in hindsight. Peer )] TJ ET
BT 26.250 514.381 Td /F1 9.8 Tf  [(support was identified as helpful, as well as physical activity and connecting with broader social networks. GPs also identified )] TJ ET
BT 26.250 502.476 Td /F1 9.8 Tf  [(other strategies of being able to manage their exposure to high and/or intense workloads, either through physically getting away )] TJ ET
BT 26.250 490.572 Td /F1 9.8 Tf  [(for a break or moving to a part-time working structure.)] TJ ET
BT 26.250 471.167 Td /F1 9.8 Tf  [(It is worth noting that no GPs mentioned that they had sought any professional support, though one GP reflected that they )] TJ ET
BT 26.250 459.262 Td /F1 9.8 Tf  [(perhaps needed it. It seems important not to assume that no requests for professional support means that it is not required. )] TJ ET
BT 26.250 447.357 Td /F1 9.8 Tf  [(Considerable stigma still exists regarding help-seeking for mental health impacts after disasters, and GPs are likely to be as )] TJ ET
BT 26.250 435.453 Td /F1 9.8 Tf  [(affected as other groups \(Figley, 1995; Spinhoven & Verschuur, 2006: North )] TJ ET
BT 357.380 435.453 Td /F5 9.8 Tf  [(et al)] TJ ET
BT 375.807 435.453 Td /F1 9.8 Tf  [(, 2002; Somers, Drinkwater & Torcello, 1997\).)] TJ ET
BT 26.250 416.048 Td /F1 9.8 Tf  [(Large scale natural disasters can pose serious challenges for business continuity and operations of existing health care )] TJ ET
BT 26.250 404.143 Td /F1 9.8 Tf  [(providers and systems, such as loss of staff)] TJ ET
0.267 0.267 0.267 rg
BT 214.825 405.650 Td /F4 8.7 Tf  [(14)] TJ ET
0.271 0.267 0.267 rg
BT 224.462 404.143 Td /F1 9.8 Tf  [( . Although some GPs in our study described how their practices had been )] TJ ET
BT 26.250 392.238 Td /F1 9.8 Tf  [(affected such that they found themselves working in locum positions, other GPs talked about increased workloads but a )] TJ ET
BT 26.250 380.334 Td /F1 9.8 Tf  [(reluctance to ask for help. Indeed, these GPs talked about how other practices perhaps needed support more than they did.)] TJ ET
BT 26.250 360.929 Td /F1 9.8 Tf  [(There appears to be a possible gap concerning a regionally coordinated process for identifying hotspots of GP patient demand, )] TJ ET
BT 26.250 349.024 Td /F1 9.8 Tf  [(and the deployment of adequate resources to meet this demand, e.g. locum support. This may partly be due to the reluctance of )] TJ ET
BT 26.250 337.119 Td /F1 9.8 Tf  [(GPs to step forward to say that they may be struggling to meet demand. However, there also appears to be a wide-scale )] TJ ET
BT 26.250 325.215 Td /F1 9.8 Tf  [(increase in service demand due to secondary stressors such as insurance issues that puts pressure on existing services )] TJ ET
BT 26.250 313.310 Td /F1 9.8 Tf  [(requiring an enhanced response or �surge capacity�.)] TJ ET
BT 26.250 293.905 Td /F1 9.8 Tf  [(A GP working as a locum in an unfamiliar location may not know enough about local resources or services that might be )] TJ ET
BT 26.250 282.000 Td /F1 9.8 Tf  [(available for their patients. Additionally, some GPs talked about their struggle to identify the pathway to facilitating financial aid )] TJ ET
BT 26.250 270.096 Td /F1 9.8 Tf  [(for patients. In both cases, GPs often found themselves working outside their area of accustomed expertise � not unusual for a )] TJ ET
BT 26.250 258.191 Td /F1 9.8 Tf  [(GP. Nevertheless, it may be wise to be forewarned of such possible extra demands in a post-disaster situation and to prepare )] TJ ET
BT 26.250 246.286 Td /F1 9.8 Tf  [(accordingly.)] TJ ET
BT 26.250 209.684 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 26.250 189.729 Td /F1 9.8 Tf  [(The authors would like to gratefully acknowledge the participants who gave their time and shared their experiences for this )] TJ ET
BT 26.250 177.825 Td /F1 9.8 Tf  [(research.)] TJ ET
BT 26.250 148.722 Td /F4 12.0 Tf  [(References)] TJ ET
BT 26.250 121.268 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 38.132 121.268 Td /F1 9.8 Tf  [(Ronan, K.R., & Johnston, D.M. \(2005\). Promoting Community Resilience in Disasters: The Role for Schools, Youth and )] TJ ET
BT 26.250 109.363 Td /F1 9.8 Tf  [(Families. Springer, New York.)] TJ ET
BT 26.250 89.958 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 38.132 89.958 Td /F1 9.8 Tf  [(Watson, P.J., Friedman, M.J., Gibson, L.E., Ruzek, J.I., Norris, F. H. & Ritchie, E. C. \(2003\). Early intervention for trauma-)] TJ ET
BT 26.250 78.054 Td /F1 9.8 Tf  [(related problems. In R.J. Ursano & A.E. Norwood, \(Eds.\), Trauma and disaster: responses and management. Washington, DC: )] TJ ET
BT 26.250 66.149 Td /F1 9.8 Tf  [(American Psychiatric Publishing.)] TJ ET
BT 26.250 46.744 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 38.132 46.744 Td /F1 9.8 Tf  [(Norris FH, Friedman MJ, Watson PJ, Byrne CM, Diaz E, Kaniasty K. 60,000 disaster victims speak: Part I. An empirical )] TJ ET
Q
q
15.000 32.458 577.500 744.542 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(The recent patient experience report in New Zealand)] TJ ET
0.267 0.267 0.267 rg
BT 253.854 768.983 Td /F4 8.7 Tf  [(12)] TJ ET
0.271 0.267 0.267 rg
BT 263.491 767.476 Td /F1 9.8 Tf  [( showed that 84 per cent of adults surveyed expressed confidence and )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(trust in their GP. Although this is advantageous in terms of building and maintaining the doctor-patient relationship, especially in )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(times of great strain and community uncertainty, it also perhaps places an additional burden on GPs in a disaster. The )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(confidence and trust that patients had in their doctors and their shared experience through the earthquakes may help to explain )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(the increased openness described by some of the GPs regarding patient health-related behaviours. Although this frankness is )] TJ ET
BT 26.250 707.952 Td /F1 9.8 Tf  [(to be encouraged, care needs to be taken to ensure that GPs have the knowledge and referral pathways available to them if )] TJ ET
BT 26.250 696.048 Td /F1 9.8 Tf  [(they perceive that short-term coping behaviours risk turning into potential health hazards.)] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(GPs also talked about threats to their income through employment displacement, and the consequent disruption and uncertainty )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(in other aspects of their lives that this brings. Furthermore, some GPs talked about dilemmas where the careful negotiated )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(balance between personal and professional life was highlighted for them. Some GPs found the structure and role of the )] TJ ET
BT 26.250 640.929 Td /F1 9.8 Tf  [(professional role less stressful than their personal lives. However, immersement in their professional role may come at some )] TJ ET
BT 26.250 629.024 Td /F1 9.8 Tf  [(personal cost as the recovery draws on.)] TJ ET
BT 26.250 609.619 Td /F1 9.8 Tf  [(In guarding against the risks of vicarious trauma and compassion fatigue, it is important that GPs have good awareness of self-)] TJ ET
BT 26.250 597.714 Td /F1 9.8 Tf  [(care and practices approporiate to sustain themselves through a disaster. GPs showed an appreciation of how they may be )] TJ ET
BT 26.250 585.810 Td /F1 9.8 Tf  [(personally affected by the earthquakes, although this was talked about when reflecting on their experiences rather than at the )] TJ ET
BT 26.250 573.905 Td /F1 9.8 Tf  [(time they were going through the response and early-recovery period. One account focusing on disaster recovery leadership )] TJ ET
BT 26.250 562.000 Td /F1 9.8 Tf  [(and leaders)] TJ ET
0.267 0.267 0.267 rg
BT 77.194 563.507 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 86.831 562.000 Td /F1 9.8 Tf  [( states that, �)] TJ ET
BT 143.196 562.000 Td /F5 9.8 Tf  [(they can face burn out at the same time the needs of the community are at their peak� )] TJ ET
BT 516.055 562.000 Td /F1 9.8 Tf  [(\(p.30\). The )] TJ ET
BT 26.250 550.095 Td /F1 9.8 Tf  [(GPs have a leadership role within their communities and as such it is important that they, �)] TJ ET
BT 415.324 550.095 Td /F5 9.8 Tf  [(have a �self-care� plan that outlines )] TJ ET
BT 26.250 538.191 Td /F5 9.8 Tf  [(routines and activities that support health, relationships and allots time for pleasure and leisure)] TJ ET
BT 433.771 538.191 Td /F1 9.8 Tf  [(� \(McNaughton, 2013, p.31\))] TJ ET
0.267 0.267 0.267 rg
BT 552.994 539.698 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 562.631 538.191 Td /F1 9.8 Tf  [( . )] TJ ET
BT 26.250 526.286 Td /F1 9.8 Tf  [(Some GPs had consciously identified a need for self-care whereas others identified beneficial behaviours only in hindsight. Peer )] TJ ET
BT 26.250 514.381 Td /F1 9.8 Tf  [(support was identified as helpful, as well as physical activity and connecting with broader social networks. GPs also identified )] TJ ET
BT 26.250 502.476 Td /F1 9.8 Tf  [(other strategies of being able to manage their exposure to high and/or intense workloads, either through physically getting away )] TJ ET
BT 26.250 490.572 Td /F1 9.8 Tf  [(for a break or moving to a part-time working structure.)] TJ ET
BT 26.250 471.167 Td /F1 9.8 Tf  [(It is worth noting that no GPs mentioned that they had sought any professional support, though one GP reflected that they )] TJ ET
BT 26.250 459.262 Td /F1 9.8 Tf  [(perhaps needed it. It seems important not to assume that no requests for professional support means that it is not required. )] TJ ET
BT 26.250 447.357 Td /F1 9.8 Tf  [(Considerable stigma still exists regarding help-seeking for mental health impacts after disasters, and GPs are likely to be as )] TJ ET
BT 26.250 435.453 Td /F1 9.8 Tf  [(affected as other groups \(Figley, 1995; Spinhoven & Verschuur, 2006: North )] TJ ET
BT 357.380 435.453 Td /F5 9.8 Tf  [(et al)] TJ ET
BT 375.807 435.453 Td /F1 9.8 Tf  [(, 2002; Somers, Drinkwater & Torcello, 1997\).)] TJ ET
BT 26.250 416.048 Td /F1 9.8 Tf  [(Large scale natural disasters can pose serious challenges for business continuity and operations of existing health care )] TJ ET
BT 26.250 404.143 Td /F1 9.8 Tf  [(providers and systems, such as loss of staff)] TJ ET
0.267 0.267 0.267 rg
BT 214.825 405.650 Td /F4 8.7 Tf  [(14)] TJ ET
0.271 0.267 0.267 rg
BT 224.462 404.143 Td /F1 9.8 Tf  [( . Although some GPs in our study described how their practices had been )] TJ ET
BT 26.250 392.238 Td /F1 9.8 Tf  [(affected such that they found themselves working in locum positions, other GPs talked about increased workloads but a )] TJ ET
BT 26.250 380.334 Td /F1 9.8 Tf  [(reluctance to ask for help. Indeed, these GPs talked about how other practices perhaps needed support more than they did.)] TJ ET
BT 26.250 360.929 Td /F1 9.8 Tf  [(There appears to be a possible gap concerning a regionally coordinated process for identifying hotspots of GP patient demand, )] TJ ET
BT 26.250 349.024 Td /F1 9.8 Tf  [(and the deployment of adequate resources to meet this demand, e.g. locum support. This may partly be due to the reluctance of )] TJ ET
BT 26.250 337.119 Td /F1 9.8 Tf  [(GPs to step forward to say that they may be struggling to meet demand. However, there also appears to be a wide-scale )] TJ ET
BT 26.250 325.215 Td /F1 9.8 Tf  [(increase in service demand due to secondary stressors such as insurance issues that puts pressure on existing services )] TJ ET
BT 26.250 313.310 Td /F1 9.8 Tf  [(requiring an enhanced response or �surge capacity�.)] TJ ET
BT 26.250 293.905 Td /F1 9.8 Tf  [(A GP working as a locum in an unfamiliar location may not know enough about local resources or services that might be )] TJ ET
BT 26.250 282.000 Td /F1 9.8 Tf  [(available for their patients. Additionally, some GPs talked about their struggle to identify the pathway to facilitating financial aid )] TJ ET
BT 26.250 270.096 Td /F1 9.8 Tf  [(for patients. In both cases, GPs often found themselves working outside their area of accustomed expertise � not unusual for a )] TJ ET
BT 26.250 258.191 Td /F1 9.8 Tf  [(GP. Nevertheless, it may be wise to be forewarned of such possible extra demands in a post-disaster situation and to prepare )] TJ ET
BT 26.250 246.286 Td /F1 9.8 Tf  [(accordingly.)] TJ ET
BT 26.250 209.684 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 26.250 189.729 Td /F1 9.8 Tf  [(The authors would like to gratefully acknowledge the participants who gave their time and shared their experiences for this )] TJ ET
BT 26.250 177.825 Td /F1 9.8 Tf  [(research.)] TJ ET
BT 26.250 148.722 Td /F4 12.0 Tf  [(References)] TJ ET
BT 26.250 121.268 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 38.132 121.268 Td /F1 9.8 Tf  [(Ronan, K.R., & Johnston, D.M. \(2005\). Promoting Community Resilience in Disasters: The Role for Schools, Youth and )] TJ ET
BT 26.250 109.363 Td /F1 9.8 Tf  [(Families. Springer, New York.)] TJ ET
BT 26.250 89.958 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 38.132 89.958 Td /F1 9.8 Tf  [(Watson, P.J., Friedman, M.J., Gibson, L.E., Ruzek, J.I., Norris, F. H. & Ritchie, E. C. \(2003\). Early intervention for trauma-)] TJ ET
BT 26.250 78.054 Td /F1 9.8 Tf  [(related problems. In R.J. Ursano & A.E. Norwood, \(Eds.\), Trauma and disaster: responses and management. Washington, DC: )] TJ ET
BT 26.250 66.149 Td /F1 9.8 Tf  [(American Psychiatric Publishing.)] TJ ET
BT 26.250 46.744 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 38.132 46.744 Td /F1 9.8 Tf  [(Norris FH, Friedman MJ, Watson PJ, Byrne CM, Diaz E, Kaniasty K. 60,000 disaster victims speak: Part I. An empirical )] TJ ET
Q
q
15.000 32.458 577.500 744.542 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(The recent patient experience report in New Zealand)] TJ ET
0.267 0.267 0.267 rg
BT 253.854 768.983 Td /F4 8.7 Tf  [(12)] TJ ET
0.271 0.267 0.267 rg
BT 263.491 767.476 Td /F1 9.8 Tf  [( showed that 84 per cent of adults surveyed expressed confidence and )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(trust in their GP. Although this is advantageous in terms of building and maintaining the doctor-patient relationship, especially in )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(times of great strain and community uncertainty, it also perhaps places an additional burden on GPs in a disaster. The )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(confidence and trust that patients had in their doctors and their shared experience through the earthquakes may help to explain )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(the increased openness described by some of the GPs regarding patient health-related behaviours. Although this frankness is )] TJ ET
BT 26.250 707.952 Td /F1 9.8 Tf  [(to be encouraged, care needs to be taken to ensure that GPs have the knowledge and referral pathways available to them if )] TJ ET
BT 26.250 696.048 Td /F1 9.8 Tf  [(they perceive that short-term coping behaviours risk turning into potential health hazards.)] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(GPs also talked about threats to their income through employment displacement, and the consequent disruption and uncertainty )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(in other aspects of their lives that this brings. Furthermore, some GPs talked about dilemmas where the careful negotiated )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(balance between personal and professional life was highlighted for them. Some GPs found the structure and role of the )] TJ ET
BT 26.250 640.929 Td /F1 9.8 Tf  [(professional role less stressful than their personal lives. However, immersement in their professional role may come at some )] TJ ET
BT 26.250 629.024 Td /F1 9.8 Tf  [(personal cost as the recovery draws on.)] TJ ET
BT 26.250 609.619 Td /F1 9.8 Tf  [(In guarding against the risks of vicarious trauma and compassion fatigue, it is important that GPs have good awareness of self-)] TJ ET
BT 26.250 597.714 Td /F1 9.8 Tf  [(care and practices approporiate to sustain themselves through a disaster. GPs showed an appreciation of how they may be )] TJ ET
BT 26.250 585.810 Td /F1 9.8 Tf  [(personally affected by the earthquakes, although this was talked about when reflecting on their experiences rather than at the )] TJ ET
BT 26.250 573.905 Td /F1 9.8 Tf  [(time they were going through the response and early-recovery period. One account focusing on disaster recovery leadership )] TJ ET
BT 26.250 562.000 Td /F1 9.8 Tf  [(and leaders)] TJ ET
0.267 0.267 0.267 rg
BT 77.194 563.507 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 86.831 562.000 Td /F1 9.8 Tf  [( states that, �)] TJ ET
BT 143.196 562.000 Td /F5 9.8 Tf  [(they can face burn out at the same time the needs of the community are at their peak� )] TJ ET
BT 516.055 562.000 Td /F1 9.8 Tf  [(\(p.30\). The )] TJ ET
BT 26.250 550.095 Td /F1 9.8 Tf  [(GPs have a leadership role within their communities and as such it is important that they, �)] TJ ET
BT 415.324 550.095 Td /F5 9.8 Tf  [(have a �self-care� plan that outlines )] TJ ET
BT 26.250 538.191 Td /F5 9.8 Tf  [(routines and activities that support health, relationships and allots time for pleasure and leisure)] TJ ET
BT 433.771 538.191 Td /F1 9.8 Tf  [(� \(McNaughton, 2013, p.31\))] TJ ET
0.267 0.267 0.267 rg
BT 552.994 539.698 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 562.631 538.191 Td /F1 9.8 Tf  [( . )] TJ ET
BT 26.250 526.286 Td /F1 9.8 Tf  [(Some GPs had consciously identified a need for self-care whereas others identified beneficial behaviours only in hindsight. Peer )] TJ ET
BT 26.250 514.381 Td /F1 9.8 Tf  [(support was identified as helpful, as well as physical activity and connecting with broader social networks. GPs also identified )] TJ ET
BT 26.250 502.476 Td /F1 9.8 Tf  [(other strategies of being able to manage their exposure to high and/or intense workloads, either through physically getting away )] TJ ET
BT 26.250 490.572 Td /F1 9.8 Tf  [(for a break or moving to a part-time working structure.)] TJ ET
BT 26.250 471.167 Td /F1 9.8 Tf  [(It is worth noting that no GPs mentioned that they had sought any professional support, though one GP reflected that they )] TJ ET
BT 26.250 459.262 Td /F1 9.8 Tf  [(perhaps needed it. It seems important not to assume that no requests for professional support means that it is not required. )] TJ ET
BT 26.250 447.357 Td /F1 9.8 Tf  [(Considerable stigma still exists regarding help-seeking for mental health impacts after disasters, and GPs are likely to be as )] TJ ET
BT 26.250 435.453 Td /F1 9.8 Tf  [(affected as other groups \(Figley, 1995; Spinhoven & Verschuur, 2006: North )] TJ ET
BT 357.380 435.453 Td /F5 9.8 Tf  [(et al)] TJ ET
BT 375.807 435.453 Td /F1 9.8 Tf  [(, 2002; Somers, Drinkwater & Torcello, 1997\).)] TJ ET
BT 26.250 416.048 Td /F1 9.8 Tf  [(Large scale natural disasters can pose serious challenges for business continuity and operations of existing health care )] TJ ET
BT 26.250 404.143 Td /F1 9.8 Tf  [(providers and systems, such as loss of staff)] TJ ET
0.267 0.267 0.267 rg
BT 214.825 405.650 Td /F4 8.7 Tf  [(14)] TJ ET
0.271 0.267 0.267 rg
BT 224.462 404.143 Td /F1 9.8 Tf  [( . Although some GPs in our study described how their practices had been )] TJ ET
BT 26.250 392.238 Td /F1 9.8 Tf  [(affected such that they found themselves working in locum positions, other GPs talked about increased workloads but a )] TJ ET
BT 26.250 380.334 Td /F1 9.8 Tf  [(reluctance to ask for help. Indeed, these GPs talked about how other practices perhaps needed support more than they did.)] TJ ET
BT 26.250 360.929 Td /F1 9.8 Tf  [(There appears to be a possible gap concerning a regionally coordinated process for identifying hotspots of GP patient demand, )] TJ ET
BT 26.250 349.024 Td /F1 9.8 Tf  [(and the deployment of adequate resources to meet this demand, e.g. locum support. This may partly be due to the reluctance of )] TJ ET
BT 26.250 337.119 Td /F1 9.8 Tf  [(GPs to step forward to say that they may be struggling to meet demand. However, there also appears to be a wide-scale )] TJ ET
BT 26.250 325.215 Td /F1 9.8 Tf  [(increase in service demand due to secondary stressors such as insurance issues that puts pressure on existing services )] TJ ET
BT 26.250 313.310 Td /F1 9.8 Tf  [(requiring an enhanced response or �surge capacity�.)] TJ ET
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