The transition from medical student to doctor brings a mixture of emotions: excitement, a sense of achievement, anticipation, apprehension, and maybe even fear.
This change can be difficult - not only are you adjusting to new physical, emotional and mental demands as a foundation doctor, you also need to cope with additional pressures and responsibilities.
Long hours, heavy workloads, the threat of litigation and patient demands can all add to a stressful working environment, not to mention the strain on the NHS from the pandemic. The General Medical Council's (GMC) national training survey from 2021 found that a third of doctors in training said their job leaves them burnt out to a high or very high degree - compared to a quarter in previous years. It's why we're working with two wellbeing charities supporting doctors in need and why our foundation doctor members can help fellow medics by joining the MDU.
So while it's important to look after yourself throughout your career, it's especially necessary at times of change or high stress - such as when starting your first job.
Focus on your successes
The qualities that drive many people into a career in medicine, such as being ambitious, dedicated and focused, can also unfortunately put these individuals at increased risk of burnout.
A contributory factor to burnout can be a feeling of isolation or not belonging (or 'imposter syndrome'). These feelings are more common than you might imagine, and it can help to discuss any concerns with trusted colleagues who will be able to reassure you.
Also consider the following ways of avoiding burnout:
- Recognise and celebrate your successes - keeping a record of positive feedback or appreciation from patients and colleagues can help.
- Don't constantly compare yourself to others. We all have different strengths and weaknesses.
- Reflect on incidents where things haven't gone to plan but don't be too hard on yourself. Reflection is a key part of clinical practice and an ethical duty. It can also help with your professional development. However, be conscious that everyone makes mistakes.
Deal with adverse incidents appropriately
Medicine can be a rewarding profession when things go according to plan and patients are happy. However, when things go wrong as a result of medical treatment, it can be devastating - not only for the patient, but also for you.
Figures from the NRLS national patient safety incident reports: commentary (September 2021) show 602,975 incidents reported to the NRLS in England between April to June 2021. That's an increase of 21.5% compared to 2020.
A previous survey of fellows and members of the Royal College of Physicians in 2014 showed that of the 1,463 respondents who had been involved in an adverse event or near miss, 76% of them felt it had affected them personally and professionally.
It's important to realise there are sources of support to help you cope in the event of an adverse incident, not least the MDU. We support thousands of members every year responding to complaints and investigations.
We have previously published advice about the support available to 'second victims' - a term sometimes used to describe clinicians coping with an adverse event. The website secondvictim.co.uk also offers support for individual clinicians and their employers.
Know when to ask for help
The 2021 GMC national training survey also identified that many trainee doctors were unclear regarding the person within their organisation they should approach if they had concerns about their health or wellbeing.
Identifying who to contact for such concerns is only part of the problem. Often a much bigger obstacle is the fear of coming forward with health or wellbeing problems.
Research carried out by the Royal Medical Benevolent Fund (RMBF) found 78% of doctors believe that doctors are so busy looking after others that they neglect to look after themselves. The RMBF report found that, "Doctors are expected to carry on and there is even a sense that needing support is a sign of weakness."
There is nothing wrong with seeking help. In fact, getting help early can prevent a problem getting bigger and avoid time spent suffering in silence.
The following advice can help.
- Identify early on in your placement who to go to in your workplace or training scheme if you have wellbeing concerns.
- If you know or suspect your judgement or performance could be affected by your health, you must consult a suitably qualified colleague (such as your GP, occupational health doctor or psychiatrist) and make any changes to your practice as they advise.
- Don't be tempted to self-prescribe to alleviate symptoms such as exhaustion or anxiety, which could leave you vulnerable to a GMC complaint. Instead, seek objective medical advice - make sure you're registered with a GP.
- Speak to your colleagues and seek their support. They may be able to help reduce the pressures you face at work.
Look after yourself
It's not just your mental health that needs attention when you hit the wards, it's your physical wellbeing too. It's important to look after your basic needs like eating, taking breaks and getting proper rest, so you can cope with the rigours of the job.
Try to pay attention to the following points.
Nutrition
A previous GMC national training survey from 2019 reported that nearly two-thirds of respondents said they didn't have access to catering or a mess room while working out of hours.
Think about bringing in healthy snacks if you can, rather than relying on vending machines. Try not to be overly dependent on caffeine to get you through a night shift, as it might disturb your sleep when you finish work.
Our article on how to eat well as a student may include some useful tips for you even now.
Sleep
Working odd shifts or runs of nights can play havoc with your body clock. An MDU survey of more than 500 doctors found more than a third feel sleep-deprived on a weekly basis and over a quarter have felt tiredness impacted their ability to treat patients.
Read our journal article on how to survive your first night shift, which includes advice on establishing good sleep habits.
Use your breaks wisely
Although it may be difficult at busy times, try to take your breaks and use them to get away from the wards or clinic. It can be tempting to cut breaks short or use them to catch up with other work such as chasing test results, but this won't give you the mental break you need.
If you can, use your break to take a walk, meet with peers or do something completely unrelated to work, even if you only have a short time.
Where else can doctors turn to for support?
Medicine is a rewarding career but it's important to be realistic about the highs and lows from the outset. Be kind to yourself, and to your colleagues. They may be going through the same emotions as you.
However you're feeling, remember that you're not alone and support is available - so ask for it early. You can access our wellbeing hub for free - including our Peer Support Network - and find more sources for support for doctors.
Read one foundation doctor's experiences starting their first year as an FY1.
This page was correct at publication on 15/07/2022. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.