The Royal Medical Benevolent Fund (RMBF) is the UK's leading charity for doctors, medical students and their families, offering financial support, advice and information for clinicians in need.

As part of their What's Up Doc campaign, launched earlier this year to raise awareness of the pressures doctors face, the RMBF released The Vital Signs. This guide sets out the key stress points for doctors and encourages them to get help early if they're feeling the strain.

The guide has now been updated with a new version aimed specifically at primary care. As medico-legal issues can often arise from situations where doctors are placed under stress or pressure, the guidance contained should prove useful for MDU members.

The guide advises that, 'Developing a good degree of self-awareness will help you be a better doctor, and will have benefits in relationships outside work. This awareness could ensure that help is sought early and before any harm is done clinically, professionally or socially.'

An RMBF survey of more than 1,000 doctors and charity supporters found that 82% of doctors know colleagues who are experiencing mental health issues like depression or anxiety, and that 84% of doctors are unlikely to reach out for fear of discrimination or stigma from colleagues.

How the MDU can help

The current stresses identified by the RMBF for GPs include the fear of making a mistake or litigation as well as constant scrutiny, review and inspection, and the MDU supports thousands of its members every year with responding to complaints and investigations.

We see first-hand the enormous personal stress that this can cause, and we also recognise that doctors who are unwell or struggling to cope may not be able to practice at their usual level and their judgment can be impaired - factors which can make them more susceptible to errors and complaints.

It's important not to feel that you are dealing with an investigation alone. As well as the RMBF's advice, we have published a guide to coping with complaints stress that provides more advice and information. We are here to support members undergoing an investigation and our medico-legal advisers can tell you what to expect, which can remove some of the fear of the unknown.

Early warning signs

So how can you spot when you or a colleague needs help? The RMBF's Vital Signs document quotes seven early warning signs to look out for to help GPs in difficulty:

1. The 'disappearing act': not answering calls, unexplained absences, frequent sick leave.
2. Low work rate: slowness in doing procedures, clerking patients, dictating letters, making decisions; arriving early, leaving late and still not achieving a reasonable workload.
3. 'Clinic rage': bursts of temper; shouting matches; reacting badly to real or imagined slights.
4. Rigidity: poor tolerance of ambiguity; inability to compromise; difficulty prioritising.
5. 'Bypass syndrome': junior colleagues or nurses find ways to avoid seeking the doctor's opinion or help.
6. Career problems: difficulty with exams; uncertainty about career choice; disillusionment with medicine.
7. Insight failure: rejection of constructive criticism; defensiveness; counter-challenge.

It also highlights that family, close friends or colleagues may be well placed to notice these signs before you are aware of them.