Intended for healthcare professionals


I’ve noticed a change in my colleague’s behaviour. What should I do?

BMJ 2019; 365 doi: (Published 10 June 2019) Cite this as: BMJ 2019;365:l2392
  1. Abi Rimmer
  1. The BMJ

It can be difficult to approach a colleague if you have concerns about their wellbeing because of a change in their behaviour. Abi Rimmer asks experts how best to handle this situation

Small gestures make a big difference

Lucy Warner, chief executive of the NHS Practitioner Health Programme, says, “If you’ve noticed a change, then this situation has probably been around for some time and may already have become a fairly serious problem. Doctors are very good at focusing on the patient in front of them and neglecting their own health. There are lots of reasons why doctors don’t seek help, both personal and logistical.

“The best thing you can do is speak up. Ask, ‘Are you ok?’ or ‘You don’t seem yourself. Do you want to talk?’ The smallest gesture can make the greatest difference. If you don’t want to speak to them directly, write a note and slip it to them. Let them know they’re not alone—we all have days when the world gets to us. You might be surprised how people open up when given the chance. Your small suggestion of help might be just what they need to take the steps towards seeking support.”

“Doctors are often concerned about the impact that seeking help could have on their career and registration. Importantly, the GMC is unlikely to want to get involved if someone is seeking treatment for a health condition. There are so many great confidential places to go —their GP, the NHS Practitioner Health Programme, NHS GP Health, and BMA Counselling (you don’t need to be a member), or peer support like Doctors Support Network and Sick Doctors Trust. We all want to help and no one needs to feel alone—please let your colleague know that.”

Take your doctor hat off

Karen Stacey, wellbeing lead for the trainee committee of the Association of Anaesthetists, says, “Everyone is entitled to a bad day but if you notice a change in your colleague’s behaviour you should keep an eye on them. If you see a more sustained change, consider how you can help. The first step should be to speak to them in person with a genuine expression of concern. As doctors, we are problem solvers, meaning we may forget to listen. Be patient, non-accusatory, and take your doctor hat off; you’re asking as a friend.

“If the opportunity arises, suggest how they might seek help. Listen first, suggest second. One chat is unlikely to solve the problem, but being a supportive and understanding listener is invaluable when someone is facing a challenging time.

“Not everyone will want to discuss their problems, but it’s important that they speak to someone. If you’re unsuccessful with your approach, but remain concerned, speak in confidence with a senior colleague. This could be anonymous initially, if you wish to confirm whether to take this matter further.

“Hopefully, your colleague’s educational supervisor will have an existing relationship with them, and may already know of current circumstances. They can approach them directly, and, depending on the circumstance, seek advice from the training programme director. There are many sources of help available for a variety of problems, and many are now tailored to medical professionals.

“As workaholic superheroes we can be our own worst enemies. Seeking help is a sign of strength, not weakness. Look out for your colleagues—they are your work family and you never know when you might need them.”

Don’t be embarrassed to ask

Peter Ilves, retired GP and associate and master trainer at 4 Mental Health, says, “We all like to believe that we’d be alert to colleagues who are struggling or becoming unwell. Certainly, I’d hope that colleagues would notice if I were that person. But the signs can be subtle so we must be attentive and ready to respond in a compassionate and appropriate way.

“It’s important to ask if there is something we can do to help and be ready to ask a second time if they seem hesitant. Many of us shy away from that first encounter, but reaching out sooner rather than later could save a life. When doing this, always approach with compassion and kindness. Doctors find it difficult to ask for help and steer away from sharing problems and their emotional distress. This culture needs to change across healthcare.

“Once a connection is made, explore whether your colleague is already being supported. If not, persuade them to talk to people they trust, occupational health, or their GP. If they seem in crisis or you think they may be at risk of suicide, ask. Please don’t let embarrassment stop you exploring that potentially life saving question. Remember, your colleague may need urgent assessment. See the newly launched BMJ Best Practice module on suicide risk management if you are unsure what or how to ask.1

“Your colleague will also benefit from a safety plan—pre-planned lists of strategies, ways to make a situation safer, and people to contact for support. This is the mental health equivalent of a seatbelt. See”