Doctors did not expect the public to stand on their doorstep and clap to show their support, and they certainly didn't ask to be assigned hero-status for doing their jobs. While the tribute was a boost, many feared that the sentiment was bound to curdle as health service resources were strained to breaking point by the pandemic.

Sure enough, the last year has been a much lonelier experience for all healthcare professionals, who are now bearing the brunt of public frustration and anger amid announcements of record hospital waiting lists and hostile media headlines about access to GPs.

This is borne out by the increasing levels of abuse and violence against doctors, and an upsurge in calls for advice and assistance from MDU members during the course of the pandemic. In 2021, our team assisted with 40,000 such requests, up from 35,000 the previous year. This was largely driven by a rise in patient complaints as well as members seeking support with coroners' investigations and clinical incident inquiries.

Very often, these members contact the MDU in great distress because a patient has been harmed, or they are deeply anxious about their career and livelihoods - but also say they are comforted by the fact that they can speak to someone who has been in their shoes, whenever they need to. It goes to the heart of our 'doctors for doctors' ethos that we employ over 70 doctors and dentists on our staff who are truly able to empathise with our members' circumstances and provide thoughtful support and guidance.

However, we are acutely aware that the members who have sought MDU assistance are the tip of the iceberg. For every doctor who contacts their MDO about a medico-legal matter, there will be many more who are now at greater risk of being involved in an adverse incident because the pandemic has left them running on empty. You can read one such account from a member in this issue.

The MDU's latest member survey highlights the physical effect of two years of practice in a state of hypervigilance. Countless studies have showed the effect that fatigue can have on our cognition and performance, but I believe this is the first insight into pandemic-related exhaustion and the practical consequences.

Of the 532 GPs and hospital doctors who responded, over a third told us they feel sleep deprived on at least a weekly basis with six in ten saying their sleep patterns had worsened slightly or significantly during the pandemic. Members reported poor concentration (64%), decision making difficulties (40%), mood swings, (37%) and mental health problems (30%). Even more worryingly, over a quarter said tiredness had affected their ability to safely care for patients, with 15% of these doctors having been involved in a near miss and 3% reporting that a patient was harmed.

When I qualified, punishing hours was a career rite of passage, but junior doctors generally felt supported by their 'firm' and routinely had access to a rest room and all-night canteen during a night shift. Today, the nature of clinical care has become more complex and intense but few doctors have access to these facilities - and that is not a sign of progress. As our survey clearly shows, fatigue is a patient safety risk, as much as faulty equipment or poor infection control.

We were pleased to see the GMC update its guidance for decision makers in fitness to practise cases in recognition of the challenging circumstances of the pandemic, including "sustained and extreme periods of fatigue". This is especially welcome as, in our experience, a fitness to practise investigation can be the tipping point for doctors who are experiencing mental health problems.

However, we believe that more needs to be done by the government and NHS organisations to address the issue of fatigue and doctors' welfare more generally, or we are likely to see more cases of burnt-out doctors, and more leaving the profession.

Two years into the pandemic, it is clear that this is the toughest period that most doctors will face in their working lives and it is imperative that they are properly supported. In addition to core services such as our 24-hour advice line, the MDU has launched a series of initiatives to support members' wellbeing, including our Peer Support Network, our free wellbeing helpline for GP practices, and raising money for medics in need through an initiative we undertook to support the Royal Medical Benevolent Fund and the Doctors' Support Network.

I am proud of the MDU's response to this health crisis and I believe it shows the true value of our being a mutual organisation which is wholly owned by and answerable to its members. For more than 137 years, our sole purpose has been to support members when they need us - and we will continue to support them when the harrowing conditions of the pandemic start to fade from public memory.