Intended for healthcare professionals

Opinion Taking Stock

Rammya Mathew: Doctors are being pushed to the absolute brink

BMJ 2022; 378 doi: (Published 10 August 2022) Cite this as: BMJ 2022;378:o1997
  1. Rammya Mathew, GP
  1. London
  1. rammya.mathew{at}
    Follow Rammya on Twitter: @RammyaMathew

Like most doctors, I’ve got a few type A personality traits. I’m ambitious, I take pride in my work, and I want to be good at what I do. At face value these all seem like desirable characteristics for a doctor, but they can also mean that we find it hard to recognise—or indeed accept—when work is getting the better of us.

Only with the benefit of hindsight have I recognised the times when I’ve been under immense work related stress. One of these times was when I’d newly qualified as a GP: I was working five sessions as a salaried GP and four sessions doing a GP leadership role. My week was full, I took work home every day, and however much I tried to clear the decks I just came back to more and more work.

As a result I found it hard to unwind at the end of the day or switch off at night, and I had periods of terrible insomnia, which in turn made my ability to cope even more precarious. Ironically, it’s only when I went on maternity leave with my first child and started to sleep better (any new parent will tell you how absurd that sounds) that I realised the impact my work was having on my wellbeing. I didn’t confide in anyone at the time—partly, I’m sure, because I desperately wanted to be seen as a GP who was excelling and not struggling to keep my head above water.

This year, however, I’ve started doing appraisals for fellow GPs, and I’m beginning to realise just how many of my colleagues are experiencing or have experienced significant trauma or ill health as a result of work. We’re always hearing about GP numbers incessantly declining, but what we don’t hear are the stories behind this—countless tales of doctors being pushed to the absolute brink. If we don’t all open up and share our vulnerabilities we’ll never know the full scale of the problem, and it also perpetuates a belief among doctors with stress and burnout that the problem sits with them. Many will be left thinking, “If everyone else can cope, why can’t I?”

The recent death of Gail Milligan,1 a GP whose suicide is believed to have been caused by a prolonged period of stress at work, has brought this issue to light. I believe that workloads need to be tackled as a priority, but I also want other doctors like Gail to know that they’re not alone in their experiences, as almost all of us have felt broken by our work at some point.

As medics, it may not come naturally to us to talk about career low points or failing to cope—but if you can do it, tell your story. If this encourages even one person to open up about their struggles and to reach out for help, it’s worth doing.

Support for doctors in the UK


  • Competing interests: None.

  • Provenance and peer review: Commissioned; not externally peer reviewed.


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