Stress less and avoid risk as a foundation doctor

This isn’t ‘have a bubble bath and eat kale’ advice.  

Of course, that stuff is really important. But here I want to help you explore how you can plan to deal with the stresses of real-life frontline medicine - the sort where the bleep never stops, the rota’s tight, your supervisor is probably overwhelmed too, and you’re running on caffeine and guesswork. 

What might you be stepping into? 

• New responsibilities 

• Steep learning curves 

• Situations where you feel out of your depth 

• Colleagues you aren’t familiar with and with whom you will need to build trust 

• Patients with complex presentations 

• Emotional exposure (tied to both patients and colleagues) 

• Fatigue that erodes your judgement, and 

• Working environments in which reality does not always align with your expectations and professional values. 

Managing yourstress and wellbeing will be a patient safety issue as you do your best to navigate these new, complex, and challenging environments.  

When your well-being suffers, you may start to feel stressed, tired, and anxious, and your professional behaviour can slip - not because you’re unprofessional, but because you’re human. 

Consider the following typical cases: 

Scenario 1 

You’re alone on a night shift, unsure about a patient deteriorating. You hesitate because you don’t want to seem incompetent. You fear the wrath of your overloaded colleagues. You feel isolated and also experience a substantial amount of impostor syndrome. This hesitation results in a delay in escalation, an avoidable deterioration of the patient's condition, and a serious incident review. 

Scenario 2 

You’ve just finished a busy shift, six patients in, alarms going off, and barely a moment to write proper notes. Then a patient takes a turn for the worse after you’ve left - and when your decisions are questioned, there’s nothing in the notes to back you up. 

Scenario 3 

After a failed resuscitation, you find yourself in tears in the staff toilet. But there’s no time to process what’s just happened - you have to carry on. Later in the shift, you snap at a nursing colleague. Tensions rise, and what started as emotional overload ends with a formal complaint and an allegation of bullying. 

In most cases we assist with, our members have undoubtedly been trying their best. But when we look at their working circumstances, they are often tired, isolated, scared to escalate a situation, or simply overwhelmed. 

As an organisation, MDDUS works to influence government, NHS bodies, and other stakeholders to create working conditions in which resilience is not undermined, and wellbeing is at the forefront of planning and strategy.

Strategies to support your longer-term wellbeing

In the meantime, here are some approaches and strategies that, when practised in advance, will support you in times of high stress and also support your longer-term wellbeing. 

1. Focus on your circle of control/influence. 

This is difficult - but try to avoid worrying about aspects of the environment, the organisation, or your role that you cannot directly control or influence.  

Focus efforts instead on the aspects you can control, and which will support safety – primarily, building effective relationships with colleagues and developing a better understanding of your patients.  

Seek support in understanding systems of working, other departments/services, processes, procedures, and technology.  

2. Deploy a state break. 

Every human is vulnerable to what Daniel Goleman calls ‘emotional hijack’.This relates to the complex circuitry, widely dispersed throughout our brain, designed to detect threats.  

Fear, or any other surge of intense emotion, can affect your ability to process information and make sound decisions.  

This phenomenon can lead to poor communication, defensive or unprofessional behaviour, impaired decision-making, and damaged relationships with colleagues or patients in high-stress environments. 

State breaks are simple strategies that can be deliberately deployed to change our physical or mental focus to prevent emotional hijacking. 

They allow you to reset and respond more calmly or effectively to challenging situations.  

Here are some examples. 

During a stressful shift 

If you’re starting to feel overwhelmed or panicked, step out of the clinical space briefly - find a quiet space if possible. Take 10 slow, deep breaths. Feel your feet firmly on the ground and gently relax your shoulders. This short pause can help reset your nervous system, allowing you to return with greater calm, focus, and clarity. 

After a difficult interaction  

If a senior colleague snaps at you, or a distressed relative lashes out, pause and say to yourself, “That was tough. Just breathe.” You might clench your fist briefly, then release it - using that small physical action as a cue to let go of tension. This simple reset can help stop unhelpful thoughts from spiraling and allow you to refocus on what needs to happen next. 

Noticing negative self-talk 

When you catch yourself thinking, “I’m not good enough for this,” pause and take a grounding breath. Gently challenge that thought by replacing it with something more compassionate, like: “I’m learning - everyone starts somewhere.”  

This small shift helps your brain move out of self-criticism and into a more resilient, growth-focused mindset. I work with senior clinicians daily who will admit to experiencing doses of impostor syndrome – even now. 

These strategies are quick and portable—you can create a state break in seconds on a ward.  They will help you maintain professionalism under pressure and support patient safety by helping you stay mentally present and clear-headed. 

Practising them builds emotional regulation, which is essential in the longer term for managing stress and avoiding burnout.  

3. Practice escalation scripts 

It’s not weak to escalate. It’s professional. 

A range of well-known scripts have been designed to support professional and effective escalation to colleagues.  

Look at these examples to see which feels most comfortable and use them to reflect on situations in which you could have done better. Reflecting and practising wording in advance can relieve the stress of deploying an escalation strategy in the moment.  

SBAR – Situation, Background, Assessment, Recommendation 

Situation 

I’m calling about Mr John Smith, a 72-year-old male. I’m concerned because he’s suddenly become very short of breath and hypotensive. 

Background 

He came in with community-acquired pneumonia and has been on IV antibiotics for two days. He has a history of COPD and heart failure. 

Assessment 

His BP is 85/50, HR is 120, RR is 28, sats are 88% on 15L O2, and his temp is 38.5. He looks unwell and is using accessory muscles. I’m worried about possible sepsis or acute pulmonary oedema. 

Recommendation 

I think he urgently needs a senior review. Can you come now, or advise how I should manage him in the meantime?          

iSBAR – as above, but adding your information helps when communicating over the phone, or to a new colleague – e.g. ‘Hi, I’m Dr Anderson, an FY1 on Ward 3B.  

PACE is used in aviation and patient safety training to escalate concerns - safely, gradually and assertively. 

Probe – “I’m not sure this patient is stable. Can we double-check?” 

Alert – “I think we may have a problem here.” 

Challenge – “I’m concerned this patient is deteriorating and needs urgent review.” 

Emergency / Escalate – “I’m not comfortable managing this alone. I need someone to attend urgently.” 

CUS - easy-to-remember phrases to ‘raise the flag’ clearly. 

 I’m concerned, I’m uncomfortable, this is a safety issue.