The Wellbeing Club

Training in the UK means moving. Sometimes every six months. Sometimes across the country. You learn a new IT system, a new team, a new commute, a new car park — and then you do it again. The psychological cost of this is rarely discussed.

What this does to you

• Chronic anticipatory anxiety — you are always partially bracing for the next move, which makes it hard to invest in the current one
• Relationship strain — partners and families carry the instability too, and their resentment (or your guilt about it) accumulates quietly
• Identity fragmentation — "Who am I at this hospital?" becomes a question you ask more often than feels comfortable
• Imposter recurrence — every new rotation resets your competence clock, even when your skills haven't changed

Nobody talks about this enough. You trained for a decade. You carry student debt. You pay for exams, courses, GMC registration, indemnity, and CPD — often out of pocket and often while relocating. Meanwhile, the cost of living has outstripped pay rises for years.

Common financial pressures in training

• SCE and MRCP exam fees (often hundreds of pounds per sitting, sometimes multiple attempts)
• Dual housing costs during rotations — paying rent in two locations or long commutes
• Childcare costs that don't align with shift patterns
• The hidden costs of "portfolio building" — conference fees, courses, travel
• Pension contributions that feel abstract against immediate financial pressure

Burnout gets the headlines, but moral injury is often the deeper wound. Moral injury occurs when you are required to act — or unable to act — in ways that contradict your professional values. It is the gap between the care you want to give and the care the system allows you to provide.

You might recognise it as:

• Guilt about clinic letters that are six weeks behind
• Shame when you discharge a patient too early because there are no beds
• Anger at a referral pathway that takes longer than the disease
• A quiet sense that you are becoming the kind of doctor you once criticised

Day 1 post-nights (the transition day)

• Sleep until early afternoon (set alarm for 1–2 pm)
• Get outside in daylight by mid-afternoon — the single most effective circadian resetting signal
• Avoid caffeine after 2 pm
• Eat your main meal at a normal dinner time — meal timing is a secondary circadian entrainer
• Aim for bed at 10–11 pm even if you don't feel tired — dim lighting from 9 pm

Day 2 post-nights

• Wake at a normal time (alarm for 7–8 am)
• Morning light exposure within 30 minutes of waking
• Resume normal meal timing
• You may still feel groggy — this is normal. Full circadian realignment takes 2–3 days

Most doctors don't finish work when they leave the hospital. The patients come home with them — in their thoughts, their dreams, their distraction at dinner.

Before you leave the building

• Write down anything unfinished that needs to be done tomorrow. Getting it out of your head and onto paper reduces overnight rumination.
• Ask yourself: "Is there anything from today that I need to talk about?" If yes, decide who and when. If no, give yourself permission to close the day.
• Choose a physical transition point — the car park, the hospital entrance, the bus stop. When you cross that point, the clinical day is over.

The 5-4-3-2-1 Grounding Technique

When your thoughts are racing or you feel detached, this brings you back into the present moment through your senses:

• 5 things you can see (name them specifically — not "the wall" but "the crack in the ceiling tile")
• 4 things you can touch (feel the texture deliberately)
• 3 things you can hear
• 2 things you can smell
• 1 thing you can taste

The Containment Exercise

If a specific patient or event is dominating your thoughts:

1. Visualise a container — a box, a safe, a locked room. Whatever feels secure.
2. Mentally place the thought, image, or feeling inside it.
3. Close and lock it. Tell yourself: "I will open this when I am ready, in a safe place, with support if I need it. But not now."
4. This does not suppress emotion — it schedules it. You are not ignoring the difficult thing. You are choosing when and how to process it.

Physiological Sigh

The fastest evidence-based method for reducing acute stress in real time:

• Take two sharp inhales through the nose (first fills the lungs, second tops them up and re-inflates collapsed alveoli)
• One long, slow exhale through the mouth
• One cycle is often enough. Repeat up to three times.

You already know about sleep hygiene. This section is for the 3 am ceiling-staring that happens when you know what you should do and can't do it.

The 15-minute rule

If you haven't fallen asleep within 15 minutes, get up. Go to a dimly lit room. Do something low-stimulation: a boring book, a gentle podcast, folding laundry. Return to bed when you feel genuinely sleepy. Lying in bed awake trains your brain to associate bed with wakefulness.

The "cognitive shuffle"

Pick a letter. Think of random, unrelated words beginning with that letter. Visualise each one briefly: Apple. Accordion. Anchor. Antelope. The deliberate randomness prevents your mind from forming anxious narratives and mimics the cognitive pattern of sleep onset.

Name the worry, park it

Keep a notepad by the bed. Write the thought down — even one word. "Clinic." "Mrs B's result." "Rota." Then close the notebook. You have told your brain: "This is noted. You can let go of it until morning."

There will be periods when you do not have the energy for a gym session, a walk, a social event, or a phone call. These are the tools for those periods — the absolute minimum that still moves the needle.

Minimum viable self-care

• Drink one glass of water. Dehydration worsens cognitive fatigue and mood. One glass.
• Stand outside for 90 seconds. Fresh air and daylight. You don't have to go anywhere.
• Send one text to someone you trust. It can be as short as "having a rough one." Connection, even minimal, is protective.
• Change one item of clothing. Taking off your scrubs creates a physical transition between roles.
• Eat something that requires no preparation. A banana. A piece of toast. Nutrition does not have to be optimised to be useful.

Psychologist Jenny Taitz describes stress resets as brief, deliberate interruptions to the stress cycle — not replacing difficult emotions, but creating enough space to respond rather than react.

Three resets you can do anywhere

• The cold water reset: Run cold water over your wrists for 30 seconds. This activates the dive reflex and lowers heart rate. You can do this at any hospital sink.
• The reappraisal pause: Before a stressful situation, tell yourself "I am excited" rather than "I am anxious." Research shows that reframing arousal as excitement improves performance more than trying to calm down.
• The 90-second rule: The neurochemical lifespan of an emotion is approximately 90 seconds. If you can ride out the initial surge — without adding a story to it — the intensity will naturally diminish. Notice it, name it, wait.

Burnout was formally defined by Maslach as having three components. It is occupational — it arises from work, not from you. Understanding the components helps you identify where you are and what needs attention first.

1. Emotional exhaustion

Feeling drained, unable to face the day, nothing left to give. You may notice you are counting down the hours, dreading patient contact, or feeling physically heavy with fatigue that sleep doesn't fix.

2. Depersonalisation (cynicism)

Emotional distancing from patients and colleagues. The dark humour stops being funny and starts being how you actually feel. You may notice you've stopped using patients' names, or that you've become the person who says "they're just a frequent flyer."

3. Reduced personal accomplishment

The sense that nothing you do matters. That you are not making a difference. That your training was wasted. This is the component that erodes identity.

Three things tend to shift the dial on burnout recovery:

1. Taking control

Identify one area of your work where you can reclaim agency. It might be small — saying no to one committee, blocking one afternoon for admin, leaving on time once a week. Control is the antidote to helplessness.

2. Aligning your values

Ask: "What parts of my work still feel meaningful?" Then do more of those things and less of the things that drain you without purpose. If nothing feels meaningful, that is important information — it means the misalignment is severe and needs addressing, not ignoring.

3. Finding your people

Isolation amplifies burnout. Connection is protective. This does not mean networking events — it means finding one or two people who understand what you are going through and with whom you can be honest without performing. Schwartz Rounds, Balint groups, or even a regular coffee with a trusted colleague can serve this function.

In endocrinology, death is less frequent than in acute medicine or oncology — but it happens. The young woman with adrenal crisis. The patient with anaplastic thyroid cancer. The long-term diabetes patient whose complications finally caught up. These deaths carry a particular weight because they are often people you have known for years.

What professional grief looks like

• A heaviness you can't name after a patient dies, followed by guilt that you "shouldn't" feel this way about a professional relationship
• Dreaming about patients
• Emotional numbness — a protective shutdown that worries you because you think you should feel more
• Over-identifying with a patient — seeing your parent, your partner, yourself in them
• Questioning your clinical decisions long after they were made

What helps

• Name the loss. To yourself, to a trusted colleague. "I'm sad about Mrs J." That sentence is enough.
• Rituals matter. Some doctors write a brief note in a private journal. Some take a moment of silence before moving on. Some attend the funeral if it feels right. Find your own ritual.
• Schwartz Rounds. These exist for exactly this purpose — a safe space to talk about the emotional impact of clinical work. If your Trust runs them, attend.
• If a specific death is haunting you — intrusive images, replaying the scenario, difficulty concentrating — this may be a sign of traumatic grief or secondary traumatic stress. Speak to someone. Practitioner Health or DocHealth both understand this.

Losing a parent, a partner, a friend, a child — and going back to work the next week. Telling patients "I'm sorry for your loss" when your own loss is still raw. Looking composed in clinic while falling apart in the toilet between appointments.

Doctors are particularly bad at taking time off for grief because the system teaches us that we are indispensable and because stillness feels more frightening than busyness.

What you need to know

• There is no correct timeline for grief. The idea that you should be "over it" after a certain period is wrong.
• Grief is not linear. You will have good weeks and then a sound, a smell, or a Tuesday will undo you.
• Working through grief is not the same as avoiding grief. If work is helping you — genuinely helping — that is okay. If work is a way of not feeling, that will eventually catch up.
• You are entitled to bereavement leave. Use it. The ward will survive without you.

There is more support available than most returning doctors realise. Don't be shy to ask for it. It exists because people before you needed it, used it, and came back stronger because of it. Ask colleagues who have recently been through the schemes. They'll know which ones are running, what to expect, and how to navigate the process.

SuppoRTT — Supported Return to Training

NHS England's programme for any doctor who has been out of training for 3 months or more. It provides funding for courses, simulation, and educational activities. You can request shadowing for on-calls, attend funded refresher courses, and access coaching and mentoring. Ask your Training Programme Director or local SuppoRTT lead what is available in your region.

CaReForMe — Career Refresh for Medicine

The NHS England programme (previously HEE Return to Practice) for doctors who have had a break from clinical practice, including those new to the NHS. It supports a structured, supervised return to safe and confident practice.

Professional Support Unit (PSU)

A free, confidential service offering coaching, career guidance, and dedicated Returning to Practice workshops. Available by self-referral in most regions. If you are in London, the PSU runs regular group sessions specifically for doctors returning after time out. Go. These things work when you let them.

NHS Practitioner Health

If your mental health has been affected, whether during your break or since returning, Practitioner Health is a free, confidential primary care service for healthcare professionals across England and Scotland. Self-referral is straightforward. They saved lives during COVID. They continue to do so every day. They saved mine.

Coaching

If you can access coaching at this stage, take it. Coaching at this point is not a luxury. It is one of the most useful things you can do. It is forward-focused, practical, and it helps you see clearly what is working and what isn't. Some deaneries fund it through SuppoRTT or PSU. Ask. The worst they can say is no.

If you are a busy parent, and especially a busy mum, this is where you need to be. We will support each other to get there and find the way to sustainability, because I think a balance of work and being a mum is hard. You might not feel like you are at your best at either. That is the honest truth. But you are not alone. There are so many people in exactly the same place. We just don't open up to each other. I am not sure whether doctors particularly worry it might look like weakness, or a lack of commitment. It isn't. It is the reality of doing two of the hardest jobs in the world at the same time.

You are a doctor. You are not a superhuman. You are also a loving parent, a friend, a sibling, and a great person to someone. Don't forget that. You can be just you, and you will be loved and safe.

Practical things that help

• Don't miss your KIT days. You are entitled to up to 10 Keeping In Touch days during maternity or adoption leave. You will be paid for them. You can use some to cover mandatory training so it doesn't pile up for your return. Plan them early.
• Consider part-time if you can afford it. It gives you extra time for your little ones. And yes, for the washing, though the washing is never the priority.
• Allocate some days that are just for you. Self-love is a key part of burnout prevention. Exercise, meditation, headspace, whatever works for you. It is not selfish. It is how you sustain this. These things were life-saving for me through COVID and post-maternity. I mean that literally.
• Always ask for NHS discount. It sounds small but it adds up. Every hospital, every service, ask.
• Don't worry about saving right now. Especially when you have little ones in nursery. Consider part-time if you can. This phase passes faster than you think.

Look after your health too

If you notice that your mood is low, you are not sleeping, you have lost your appetite, you are tired all the time, please see your GP. Check your vitamin D, iron studies, and haemoglobin. Doctors get anaemia too, you know. Post-partum thyroiditis is common in endocrinologists' patients, and it happens to endocrinologists too.

If your low mood remains, ask for help. Complete a self-referral form on Practitioner Health. They saved my life. I say that without exaggeration, and without embarrassment. They are there for exactly this moment.

Imposter syndrome is almost universal among returning doctors. The longer the break, the louder the voice. It says: "Everyone else is ahead of you. You've been left behind. They'll find out you don't know enough."

Here is the truth: you have not been left behind. You have been somewhere else. And "somewhere else" gave you perspective, resilience, and life experience that doctors who never stepped away will never have.

Don't look at what others achieved while you were away

They are not on your journey. Their publications, their appointments, their LinkedIn posts, those are their milestones. Not your measuring stick. Comparison is the fastest way to erode the confidence you are trying to rebuild. Their path is not yours. Your path is not theirs. That is not failure. That is the whole point.

Positive affirmations for returning doctors

These are not motivational posters. They are reframes for the thoughts that will ambush you at 7:45 am on a Monday morning.

• "I don't know enough" → You know more than you think. The parts you have forgotten, you will relearn faster than you learned them the first time.
• "Everyone can tell I've been away" → Nobody is scrutinising you as hard as you are scrutinising yourself. They are worried about their own patients, not your CV gap.
• "I should be further along by now" → There is no "should." Your path included a detour that gave you things a straight road never could.
• "I'm going to make a mistake" → Every doctor makes mistakes. What makes a good doctor is recognising them, asking for help, and learning. You already know how to do that.
• "I can't do this" → You survived medical school, house jobs, nights on call, exams, and everything that came before. You can do this. Start small. Build.

Building boundaries and learning to say no

When you return, people will ask you to do things. Join this committee. Take on this audit. Cover this clinic. Your instinct, especially if you feel like you need to prove yourself, will be to say yes to everything.

Don't. Not yet. Say: "Thank you for thinking of me. I'm focusing on my clinical practice first, and I'll take on additional projects when I feel ready." That is a complete sentence. It is professional. It is boundaried. And it protects your recovery.

Step 1 — Self-screening

Before seeking referral, consider whether your experiences are consistent with ADHD. The WHO Adult ADHD Self-Report Scale (ASRS) is a validated 6-question screening tool freely available online. A positive screen does not confirm ADHD — it suggests formal assessment is warranted.

Step 2 — GP referral

Book a double appointment with your GP. Explain your concerns. Ask for referral to an NHS adult ADHD assessment service. Bring specific examples of how symptoms affect your daily functioning — not just at work but across your life.

Step 3 — Assessment

A formal ADHD assessment involves a detailed clinical history (often 1–3 hours), collateral history from someone who knew you in childhood (usually a parent), and standardised rating scales. It may also involve cognitive testing. The assessor will consider other conditions that can mimic ADHD (anxiety, depression, sleep disorders, thyroid dysfunction — yes, that one is yours to rule out).

Step 4 — If diagnosed

• Medication: Stimulant medication (methylphenidate, lisdexamfetamine) is first-line for adult ADHD in the UK. Many doctors with ADHD report that medication is transformative — not because it makes you "normal" but because it reduces the effort required for tasks that neurotypical brains do automatically.
• Coaching: ADHD coaching focuses on practical strategies — organisation systems, time management, task initiation — tailored to your brain. This can be as valuable as medication.
• Workplace adjustments: Under the Equality Act 2010, ADHD is a protected disability. Reasonable adjustments might include additional time for administrative tasks, a quieter workspace, or flexibility in how you structure your clinics. You do not have to disclose to your employer — but if you choose to, occupational health can facilitate adjustments.