My name is Michael, and I am a urology ST5 registrar based in the West Midlands. Growing up in a Far East Asian household, I watched my father, a gynaecologist, and my mother, a parasitologist, devote countless hours to their work while providing me with a comfortable life. They sacrificed everything, and naturally, I adopted their work ethic and martyrish attitude towards medicine.
This likely resonates with many surgical trainees. From day one, we’re told we must hone our craft over seven to eight years of training to become competent surgeons. The fear of mediocrity – or of being seen as a ‘problematic trainee’ – drives us forward, often to unhealthy extremes. I believed that showing weakness or slowing down was a sign of failure. I immersed myself entirely in urology and work. My identity became synonymous with being a surgical trainee – until everything fell apart.
The beginning of burnout
I cannot pinpoint the exact moment I tipped over the edge. Over the years, I tried to cope with the familiar challenges of surgical training in the NHS: passive-aggressive referrals, lack of theatre time, limited training opportunities and, at times, disrespect from other specialties.
To prove myself, I worked harder. I came in on my days off and took on extra clinics; after all, that was what an ‘excellent trainee’ did. Time away from work became time for audits and projects. My MCR was glowing. I was told I was performing beyond my stage of training and destined to be an excellent surgeon.
It felt good to be validated. But in hindsight, this external validation was the beginning of my burnout. I grew increasingly angry and frustrated. I interpreted any challenge to my decisions as disrespect and responded with defensiveness. I wanted to be invincible – emotionally stoic and technically superb.
In the evenings, I would vent to my now-wife. She was sincerely worried. But talking about my frustrations brought little relief. I began to resent my colleagues, my work and, eventually, the very specialty that once defined me. I felt empty. At times, I questioned whether my life was worth living, wondering if my loved ones might be better off without me, but each time, I remembered that my team valued me, and that kept me going. One day, after a particularly difficult on-call shift, my consultant noticed my worsening mood and anger, and advised me to go home. I felt like an utter failure.
Recovery
Looking back, that moment was a turning point. For the first time, rather than pushing myself harder, I had to confront the issues I’d long avoided: my mood, my outlook on my career, my relationships and my identity.
I referred myself to the NHS Practitioner Health service. It was the best decision I made. Within days, I was matched with a GP who specialised in physician wellbeing. I was referred to a clinical psychologist for cognitive behavioural therapy (CBT) and started on selective serotonin reuptake inhibitors (SSRIs).
"It was a painful but liberating revelation: the hospital, the department, the system – all would continue without me"
The improvement wasn’t immediate, much to the frustration of my impatient personality, but over time, I began to understand the roots of my burnout. Three key themes emerged:
1. Martyrish attitude and skewed perception
I had always seen myself as indispensable. My pride lay in my work ethic and productivity. When I went on indefinite sick leave, I realised that aside from a few individuals, most were focused on covering rota gaps and clinics. It was a painful but liberating revelation: the hospital, the department, the system – all would continue without me. I learned that I needed to live for myself, not for the institution.
2. Lack of identity outside work
During CBT, my psychologist asked how I would describe myself if I were no longer a urology trainee. It struck me that I no longer knew. Over the years, I had abandoned hobbies that once grounded me. My time away from work helped me rediscover them. I deleted work apps from my phone, protected my personal time, and ensured my phased return included space for hobbies. Now, I always make time (at least 30 minutes a day) to focus on something I love.
3. Low mood
Low mood had shadowed me for years. It compounded my fatigue and apathy. Starting SSRIs helped me find the breathing space to address the deeper issues through therapy and self-reflection.
Rebuilding myself
The time away from work allowed me to rediscover who I was: Michael, who plays the guitar, watches baseball, goes to the gym, and is a husband, uncle and brother. Slowly but surely, I was reclaiming my identity.
Final thoughts
Our lives are worth more than our jobs and ARCP comments. They are too short to spend consumed by others’ expectations, and too precious to sacrifice entirely at the altar of professional success. We can only become excellent surgeons – and compassionate mentors – when we first learn to understand and be kind to ourselves.
Recommended resources
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Dr Lilli Cooper – @drlillicooper
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Dr Mel Thacker – @the_surgeon_coach
