When one incident changes everything
Seeing distress, illness and death is part of working life for many doctors. Most experiences will over time fade into the background, lessening emotional over time. However, sometimes there is one particular incident that we can’t shake, that never fades, that gets stuck. It might have been an unexpected patient death. A resuscitation that didn’t go to plan. A serious clinical incident. A near-miss that could have ended very differently.
This article looks at how single-incident trauma can affect doctors, how PTSD can develop after one difficult event, and how therapy can help you process what happened so it’s no longer at the forefront of your brain all the time, interfering with you living and enjoying your life.
Coming up in this article
- The impact of traumatic events
- Understanding PTSD
- Why doctors are prone to PTSD
- Recognising PTSD symptoms
- What is trauma informed CBT
- Understanding & resolving risk factors for future PTSD
- Returning to work after PTSD
- Therapy with me & Next steps
Doctors series
This article is part of a series of 6 on subjects about therapy and mental health for doctors.
Links for these other 5 articles are at the end of this article.
1. When one incident changes things
Most of the time, even when you have difficult experiences, your training, professional mindset and college support enable you to cope. A situation might be upsetting, stay with you for a few days, but within a few weeks, it typically has already begun to fade into your background memory.
But some incidents are experienced differently. If you’ve witnessed an unexpected death, a resuscitation that didn’t go to plan, a catastrophic complication, or a near miss that was very nearly something more serious, there’s always the possibility of a trauma response developing. We know this is even more likely if there’s no debrief, no pause before carrying on with your duties, no opportunity to discuss with colleagues. Research has been done into the prevalence of PTSD in doctors and medics, and estimated rates vary from 8-18%, so it’s likely more common than you think.
The reason one incident can have such a powerful impact is not because it was “worse” than everything else you’ve seen. It’s because it involved a combination of high threat, responsibility, lack of control, and emotional intensity. In those moments, your brain prioritises action over processing. That’s what allows you to function professionally. The cost is that the memory may not be fully integrated afterwards. When that happens, the incident isn’t stored as something that happened and is now over. It’s stored as a threat memory, always there as a reminder, stuck at the front of your awareness. This is the point at which PTSD symptoms can develop.
2. Understanding PTSD
PTSD is basically when our brain fails to process the memory in it’s normal way. Our brain hasn’t pieced everything together, so it can’t store it in the filing cabinet of memories. Instead it’s got stuck on a couple of moments, the moment when someone died/ or was about to die.
The brain doesn’t know the situation is in the past, it thinks that at any moment something bad could happen, so it keeps us stuck in threat mode. You might find yourself replaying the event at unexpected moments. You might feel on edge at work in a way you didn’t before. You might dread certain types of calls, shifts or situations. You might feel a drop in confidence that doesn’t make sense to you, given your experience and competence.
This can be confusing, particularly for doctors who are used to being psychologically robust. There is often a sense of, “I’ve dealt with worse than this before, so why is this one getting to me?” The answer is not weakness. It’s the way the brain has accidentally got stuck and not done its job properly.
You’ll often see PTSD described in terms of:
- re-experiencing (intrusive memories, flashbacks, nightmares)
- avoidance (of reminders, situations, thoughts, feelings)
- a sense of ongoing threat (being on edge, hyper-alert, jumpy, irritable)
- and changes in mood and thinking (guilt, self-blame, shame, feeling detached)
Trauma-focused talking therapies is at the centre of PTSD treatment, with medication sometimes used alongside where needed.
I’d like to find out more
Chat with Hannah – http://hannahpaskintherapy.co.uk/book-now/
3. Why Doctors are prone to PTSD
Doctors are not immune to trauma responses. If anything, there are features of medical work that can make PTSD more likely after a serious incident.
Feeling responsible
There’s lots in medicine that’s beyond your control, and plenty that’s impacted by issues within services. Yet many medics take the responsibility of patient outcomes on their shoulders. This makes you more prone to blaming ourselves when something goes wrong.
Repeated exposure
PTSD doesn’t always result from the ‘worst’ experience, many times it happens when it’s yet another incident on top of lots of difficult past experiences – the accumulation of repeated exposure.
Poor self-care & shift work impact
For our brain to process memories in a helpful way, we need to have good sleep (the time when our brain does its processing work), as well as time to rest, reflect, and recover. If you’re someone who skips your lunch breaks, often stays late, drinks a bit too much, never take time for yourself and other such approaches, you will have an increased risk of PTSD developing.
Pushing on
You’re comfort zone is probably to keep busy. To try to box things away. To not talk about it. And just keep going. Much as this can serve its purpose sometimes, when traumatic events happen, it means that our brain doesn’t have processing time. Staff will sometimes decline debriefs, say they are fine when colleagues ask if they want to talk about it, and just make themselves busier outside of work in an attempt to push away the thoughts.
4. Recognising PTSD symptoms
Intrusive replay
The incident pops into your mind unexpectedly. Not just as a thought — as a vivid image, a moment, a sound, a detail. You might replay what you did, what you didn’t do, what you wish had happened differently. These memories will sometimes come up when you are faced with triggers, but can also pop up at random times that don’t make sense. It’s often described as feeling like you’re back in the moment, re-living what happened, with the intensity of the memory not fading over time.
Sleep disruption
Sleep is often the first to go. You might struggle to fall asleep because your mind “goes there”. You might wake early, have nightmares, or dread bedtime because nighttime has started to feel exhausting.
Feeling on edge & Hyper-vigilant
You might feel tense, jumpy, irritable, or constantly alert — even outside of work. It feels like you’re in fear moment, waiting for something bad to happen again. You might also find yourself spotting potential problems around you more often, feeling more aware of risk, more conscious of the worst case scenarios.
Avoidance
Certain situations can become impossible following the development of PTSD. This might mean you’ve asked for a change in duties, or that you’ve taken time off work. It’s normal that your brain won’t let you just carry on like normal, your anxiety will have increased, your fear become more present, and so becoming risk adverse is common.
Guilt, shame, self-blame
This is huge in doctors. Your mind may turn the event into a personal judgement: “I should have…” “I missed…” “I failed…” Even when, rationally, you know the outcome wasn’t fully preventable, and you did everything that was reasonable to expect of yourself. Your brain has got stuck on self blame and shame.
Emotional impact
PTSD also comes with common emotional impact – feeling more irritable, easily stressed, less patient, increasingly unmotivated, feeling like you don’t want to people, and things just feeling too much.
5. What is trauma informed CBT?
Trauma-informed CBT means we work with two things at the same time:
- What happened (the memory and the threat response)
- What it has meant (the beliefs and blame your mind has attached to it)
Trauma-focused CBT approaches aim to reduce re-experiencing, avoidance and hypervigilance by helping the brain properly process the memory, and by addressing the thinking patterns that keep the threat alive — particularly guilt, self-blame, and distorted responsibility.
The aim is not to erase the memory, but to allow you to remember it without being overwhelmed by distress. Over time, the incident becomes part of your history rather than something that intrudes into your present.
6. Understanding & resolving risk factors for future PTSD
How we think about an respond to life in general has a direct impact on how we will think about and respond to traumatic events.
Often when I am working with clients with PTSD, after we have completed the trauma processing of the memory, we are also looking at other areas that are long overdue some support.
This can include areas such as:
* Repeated burnout experience
* Difficulty with boundaries and work-life balance
* Problems with sleep and eating habits
* A pattern of self-criticism
* Excessive worry about lots of different things
* & more
By targeting these areas, we better equip you to manage future difficult situations.
If this might be relevant to you, have a read of my article Therapy for Doctors which covers lots of areas: http://hannahpaskintherapy.co.uk/therapy-for-doctors
7. Returning to work after PTSD
For many doctors, the best path for recovery is to take some time off whilst engaging in trauma focused therapy, and only return once the memory has been processed, and with the support of your therapist and Occupational Health.
A return to work plan often looks to gradually introduce you to situations that could be triggering, to ensure that the trauma therapy has achieved it’s aim, and to allow you to not feel overwhelmed or anxious.
8. Therapy with me & Next steps
Therapy with me
I’m a BABCP-accredited CBT therapist and I work privately with doctors across the UK online via video therapy, and in person in Cheshire.
My style is straight-talking and structured.
Read more about Hannah – http://hannahpaskintherapy.co.uk/about-hannah-paskin-therapy
I offer private therapy for self-funding clients.
I also provide limited availability for funded therapy under the Practitioner Health scheme (via OneBright). Message me to find out more.
Next steps
1. Book a free discovery call (this is optional)
2. Book your therapy assessment appointment
http://hannahpaskintherapy.co.uk/book-now/
Links for 5 more articles in the series
- Therapy for Doctors – http://hannahpaskintherapy.co.uk/therapy-for-doctors
- Therapy for Junior Doctors – http://hannahpaskintherapy.co.uk/therapy-for-junior-doctors
- Burnout in Doctors – http://hannahpaskintherapy.co.uk/burnout-in-doctors
- Decision-making anxiety & managing uncertainty – http://hannahpaskintherapy.co.uk/doctors-with-anxiety
- Return to work support for doctors – http://hannahpaskintherapy.co.uk/return-to-work-doctors
