Views & Reviews Personal View

After Mid Staffs: the NHS must do more to care for the health of its staff

BMJ 2013; 346 doi: (Published 07 March 2013) Cite this as: BMJ 2013;346:f1503

Re: After Mid Staffs: the NHS must do more to care for the health of its staff

We are not surprised that healthcare workers are much more likely than the general workforce to suffer depression, stress and anxiety. Clinical practice is a high-risk occupation for its emotional burdens. This may at least in part be due to the well-recognised psychological effects of involvement in medical errors and incidents (1).

Clinicians whose patients suffer harm often feel a deep sense of personal responsibility, and may themselves develop psychological symptoms (1). These range from sleep disorders and anxiety through to significant psychiatric symptoms. In the immediate aftermath of serious incidents symptoms are similar to acute stress disorder and affect cognition, concentration and the ability to safely care for patients. Unrecognised or unresolved symptoms may contribute to absenteeism and loss of productivity; in extreme cases clinicians may stop work completely or change careers (2).

An unsupportive or punitive response to incidents (which seems to be common in the NHS) exacerbates the symptoms, leads to reluctance to report future incidents and fosters a closed, secretive culture which is harmful to patient safety (2), as we have seen from recent events.

There are no formal systems in the NHS to detect and support clinicians who are affected in this way despite clear potential benefits for patient safety, staff welfare and NHS productivity.

The Royal College of Physicians is concerned about this phenomenon and eager to support doctors who may be affected by it. We have developed a short survey to help us find out more.

Doctors working in the NHS can take the survey by following this link;

Kevin Stewart FRCP
Royal College of Physicians

Reema Harrison PhD
Institute of Psychological Sciences
University of Leeds


1. Wu, A. Medical Error; the second victim. Bmj; 2002;320:726-7

2. Sirriyeh R et al. Coping with medical error; a systematic review to assess the effects of involvement in medical errors on healthcare professionals’ psychological well-being. Qual Saf Health Care 2010;19: e43.doi:10.1136

Competing interests: No competing interests

27 March 2013
Kevin Stewart
Clinical Director, Clinical Effectivess & Evaluation Unit
Reema Harrison
Royal College of Physicians
11 St Andrews Place, London, NW14LE