GP guest opinion: I was diagnosed with PTSD after workplace violence

Having being diagnosed with PTSD following workplace violence, Dr Bern Hard advocates for the importance of trauma-informed work spaces for GPs and other HCPs

I worked as a GP in addiction services for two decades. It is an area where medicine, ethics and politics come into sharp focus. I felt it was an area in which it was possible to make a meaningful impact on both patients and their family’s lives, as well as on the wider community.

Over time, I noticed a shift in the environment. Patients were presenting younger and more unwell, with complex trauma histories. Many were third generations of families torn apart by drugs and presenting with extremely disturbed behaviour. These challenges were aggravated by austerity measures, budgets cuts, and a move to de-professionalise addiction services, within a relentless commissioning cycle.

This resulted in an increasingly unsafe working environment. Verbal abuse was normalised. When a patient threatened to ‘smash my skull in’, it was dismissed by management as ‘hot air’. Objects were thrown, walls kicked, doors slammed. It became part of the job.

I told myself I could handle it, but I was having to emotionally detach to survive. There was no acceptable outlet for fear or distress. I felt further isolated as the prescriber – singled out for abuse and expected to maintain boundaries – as I wrestled with the often-conflicting ethical dilemmas of patient autonomy and safe prescribing

The breaking point was an incident at work where I feared for my life. Following that event, I was diagnosed with PTSD and have been unable to return to my previous work. It’s hard to overstate how deeply such experiences affect the nervous system, and the lasting impact this can have.

Frontline workers such as those in primary care are expected to carry the emotional load of broken systems. There’s an expectation that we should be endlessly compassionate, composed, and resilient. We are the gatekeepers of limited resources and absorb the anger and frustration of our patients.

Workplace violence is defined as any incident in which a person is abused, threatened or assaulted in circumstances related to their work. A survey by MDDUS in 2024 highlighted three out of four GP’s reported increased verbal aggression from patients leading to a rise in workplace stress. NHS Resolution identified key institutional failings that contributed to workplace violence including: 

• Insufficient risk assessments
• Lack of suitably trained staff
• Inadequate policies and procedures
• Inadequate protective equipment (such as panic alarms)
• Delays in colleague response to incident
• Lack of support from employers for the victim following an incident.

While burnout is a well-recognised occupational hazard, what is less often acknowledged is how closely it mirrors trauma. Both manifest as emotional numbing, intrusive thoughts, disconnection, and physical exhaustion. The difference between them is that PTSD results from traumatic experiences, while burnout stems from relentless workplace stress.

This situation is confounded by compassion fatigue, exacerbated by moral injury – described by the BMA as resulting from sustained distress due to institutional and resource constraints creating a sense of unease among doctors from being conflicted about the quality of care they can give. It leads to long-term psychological harm, with a variety of negative emotions from guilt and shame, to anger and moral disorientation.

What makes doctors particularly vulnerable is, paradoxically, our professionalism. Traits like conscientiousness, reliability, and self-sacrifice – highly valued in medicine – can also prevent us from recognising our own needs. We suppress, and push through until the cost to ourselves becomes unbearable.

Trauma-informed workplaces are urgently needed. Not just for patients, but for staff. The Government’s Office for Health Improvement and Disparities highlights physical and psychological safety as the first principle. Without assuring this cornerstone, we cannot hope to create a trauma-informed environment. We need packages of support –  that provide immediate and long-term physical, emotional and financial assistance. Managers should receive relevant training to ensure such packages of support are delivered effectively.

This is relevant for all healthcare workers, but the situation is particularly grave for GPs who are already facing a crisis in workforce recruitment and retention. In a BMA survey from last year 22% of GP respondents indicated it was unlikely they would be working as an NHS GP in the next three years. In the MDDUS survey, one in two GP’s were considering taking early retirement, or leaving the profession altogether, citing mental health and wellbeing as key considerations. If we want to even think of retaining our workforce, this has to be paramount.

I don’t pretend to have the answer. But in a society where violence seems to pervade public services from hospitals to classrooms, I believe change starts with honesty. We need to be brave enough to speak out and stop accepting this as inevitable.

I went into medicine as people fascinate me, and generally I want to help them feel better. I believe this is a sentiment echoed by almost all my colleagues. I expected hard work, lack of sleep, even some raw emotions. I did not expect daily abuse. I did not sign up to be threatened I did not imagine that doing my job would one day cost me my health.

Dr Bern Hard is a GP in South Wales with a longstanding interest in practitioner health