Intended for healthcare professionals


Making doctors better

BMJ 2018; 363 doi: (Published 03 October 2018) Cite this as: BMJ 2018;363:k4147
  1. Clare Gerada, medical director1,
  2. Cat Chatfield, quality improvement editor2,
  3. Abi Rimmer, deputy editor, BMJ careers2,
  4. Fiona Godlee, editor in chief2
  1. 1Practitioner Health Programme and GP Health Service,London, UK
  2. 2The BMJ, London, UK
  1. Correspondence to: C Chatfield cchatfield{at}

Personal resilience was never enough—systems must change

More doctors than ever are in a state of distress.1 This is true regardless of age, specialty, gender, ethnicity, seniority, or whether their health system is publicly or privately funded. Does the solution lie with the individual clinician or the system within which they work?

Rates of mental illness, emotional exhaustion, and anxiety are increasing among health professionals.23 The causes are generally the same across the world and include a lack of time with patients, loss of continuity, erosion of amenities such as on-call rooms and doctors’ messes, shift systems that undermine traditional peer and senior support, unrealistic public expectations of medicine, the industrialisation of healthcare turning it into a production line, a growing burden of administrative tasks, and being expected to deliver more with fewer resources.

Doctors increasingly work within a culture of litigation and blame, carrying the full burden of accountability despite a loss of authority and autonomy. They suffer when they can’t provide the high value care patients deserve,4 and may feel they must always …

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