Intended for healthcare professionals

Feature Essay

Doctors can’t care for patients if the system doesn’t care for them—an essay by Caroline Elton

BMJ 2019; 364 doi: (Published 06 March 2019) Cite this as: BMJ 2019;364:l968
  1. Caroline Elton, freelance psychologist
  1. London, UK
  1. drcarolineelton{at}

Improving doctors’ wellbeing requires a radical rethink, writes Caroline Elton, including a multifaceted approach, investment, and support from leaders. It should be taken as seriously at system level as, say, infection control

A GP, six years after completing her postgraduate training, comes to see me, an occupational psychologist, to discuss whether she should continue working as a doctor. She recounts an horrendous first day as a trainee doctor: desperately unwell patients and the rest of the team off sick, on annual leave, or away on courses.

I ask her if she thinks this day had any impact on her current feelings about her profession. She says that she can’t see a link, but the next day she emails: “I was thinking about your question. On reflection, it was just the beginning of a huge number of experiences that brought me to my current belief on working within NHS medicine. It just doesn’t care. It chews people up, spits them out, and then gets another well meaning chump to replace them. Sorry if that sounds harsh, and I do have some sadness in writing it, but I also think it is true.”

This sort of response is far from atypical. A 2017 survey by researchers at Manchester University found that of more than 900 GPs in England a third reported a “considerable or high likelihood” that they would quit direct patient care within five years.1 This is the highest level since the first national GP Worklife Survey in 2005.

Newspapers brim with reports of cancelled elective surgeries, failures to meet targets for emergency or cancer care, and doctors of all specialties voting with their feet.

That the NHS needs additional funds has political consensus, but parties disagree about how much and from where it should come. Without long term …

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