Your health, limits and commitments

“Coping with pressure” is one of the three assessed domains. Some scenarios ask how you’d respond when you’re unwell, exhausted, asked to do something beyond your competence, behind with work or caught between commitments. Apply the same care to your own situation as you would to a colleague’s.

When you may not be fit to work

The GMC says you should recognise if you may not be fit for work and seek independent professional advice about your fitness, rather than relying on your own assessment. If your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualified professional and follow their advice. You should also avoid seeking medical care from a family member or anyone you work closely with.

Usual starting point: tell the person responsible for the shift, arrange safe handover of your patients, and seek appropriate advice about your own health.

What could change it: how the illness affects your work and any risk to patients. A minor ailment that does not affect your work does not require you to leave. If it affects your judgement or creates an infection risk, seek advice and arrange safe cover as needed.

Compare options by what happens to your patients:

Option type	Common weakness
Carry on without telling anyone	Relies on your own assessment of your fitness, which the GMC says not to do.
Go home immediately without handover	Your health is addressed but your patients are left without care.
Self-medicate or ask a colleague for an informal prescription	Avoids independent advice and blurs professional boundaries.
Tell the senior and arrange handover before leaving	Usually addresses both your health and continuity of care.

Fatigue and pressure

The GMC’s working-under-pressure advice says that if your performance or judgement is compromised by your working environment, you should raise this with your employer, clinical supervisor or educational supervisor. It also suggests checking whether colleagues are safe to drive home after a shift.

Rest is not a failure to cope. “Stay late every night to finish” can leave an unsustainable and possibly unsafe pattern unaddressed. Look for options that arrange safe care today and raise the recurring problem with someone who can change it.

Working beyond your competence

You must recognise and work within the limits of your competence, and practise only under the level of supervision appropriate to your role and the task.

Usual starting point: if asked to do something you are not competent or authorised to do, say so honestly and seek supervision or an appropriate alternative. Do not attempt it unsupervised to avoid seeming unhelpful.

What could change it: a genuine emergency with no one more competent available, where delay would cause greater harm. Then do what you can safely do while getting help. Pressure from a senior or a patient does not by itself create an emergency.

A refusal alone is often weaker than a refusal combined with a plan: “I haven’t been signed off for this. Can you supervise me, or should I ask the registrar?”

Clashing commitments

Questions may set clinical work against teaching, an assessment, a rota commitment, an audit deadline or a personal event.

Usual starting point: patients who need care now come first, but commitments do not simply disappear. Tell the people affected early, use legitimate routes (swap shifts through the rota coordinator, request leave properly, ask for a deadline extension) and do not fake attendance or completion.

What could change it: if no patient needs your immediate attention and the clinical work can safely wait or be handed over, protected teaching or a booked assessment may be the appropriate place to be. “Clinical work always wins” is as unreliable as “my training always wins”.

Watch for options that solve the clash dishonestly: signing an attendance sheet for a session you missed, asking a colleague to cover without telling the rota, or calling in sick to attend a personal event.

Your own mistakes and feedback

When you have made an error, the duties in colleagues, errors and workload apply to you: make the patient safe, involve a senior, be open with the patient, and report. When you receive criticism, the strongest options usually involve reflecting on it and discussing it with your supervisor, rather than defending yourself immediately or ignoring it.

Seeking support for your own distress, for example through your educational supervisor or occupational health, is a legitimate action and can rank well. Check whether your chosen actions also address any unresolved patient-care issue.