A Fitness to Practise referral can cause a genuine trauma response because so much is at stake: your career, income, reputation and identity. Triggers can be sensory, situational, emotional, physical or relational. Learning to recognise your own triggers, building a calming toolkit, and having a plan for who to contact when things feel overwhelming can all help. If you are in crisis, call 999, NHS 111 or Samaritans on 116 123.
Key takeaways
- A strong reaction to a referral is common; don't trivialise it.
- Triggers can be sensory, situational, emotional, physical or relational.
- Once you can name your triggers, you can begin to interrupt them.
- Build a simple toolkit and a plan for who to contact if things become too much.
Trauma is not just an event; it is the lasting imprint it leaves on the mind and body. Psychiatrist Bessel van der Kolk, author of The Body Keeps the Score, describes how traumatic experiences can resurface through involuntary emotional and physical reactions long after the original danger has passed. These reactions, known as triggers, are signals to the nervous system that something familiar is happening again.
Registrants often describe being shocked by the trauma symptoms they experience after a referral. Their life wasn't in danger, so why such a strong response? Because the potential impact of a Fitness to Practise case is so wide-reaching: on your career, finances, reputation and sense of self. Don't trivialise it.
What can a trigger look like?
- Sensory: a sound, smell or visual cue, such as the ping of an email you fear is from the NMC, or a tone of voice that makes you panic that someone will report you.
- Situational: places, anniversaries, receiving NMC correspondence, attending a hearing, or reading a document that takes you straight back.
- Emotional: feeling rejected, criticised or questioned. A webinar or a conversation can bring back feelings you thought you had buried.
- Physical: butterflies, nausea, shaking, tearfulness or a strong urge to run away.
- Relational: conflict, authority figures or intimacy. You may start to expect others to treat you as badly as you were treated, and the stress can spill into close relationships.
The good news is that once you begin to identify these patterns, you can begin to interrupt them.
A simple routine for difficult moments
1. Take a pause
Find a quiet, comfortable space free from distractions. Take a few slow breaths and let yourself arrive in the moment before you do anything else, including opening a letter or starting to write.
2. Build a toolkit
- Name your intention: what do you want to understand or get done today?
- Go gently: listen to your limits and take breaks when you need them.
- Keep calming things nearby, such as a weighted blanket or something grounding to hold.
- Use a timer: short sessions of 10 to 15 minutes are often more productive than long ones.
3. Plan ahead
- Allow whatever comes up, whether it's clarity, discomfort, grief or numbness, without rushing to fix it.
- Look after your body: water and something to eat nearby.
- Know who you can reach if it becomes overwhelming: a therapist, a trusted friend or a crisis line.
- End with something kind for yourself: a walk, music, a warm drink or simply sitting quietly.
It's an ever-changing process. You won't always feel the same, and it won't always affect you in the same way.
Where to get help
If you are in crisis, call 999 or go to A&E if your life is at risk, call NHS 111, or call Samaritans free on 116 123 at any time. The NMC also funds an independent, confidential Careline for people going through Fitness to Practise. See looking after your mental health during an NMC investigation for more support, and download our FtP triggers grounding toolkit.
Frequently asked questions
Choose a set time to open NMC correspondence, with someone you trust nearby if possible, and use a grounding routine before and after.
Speak to your GP or a counsellor, and consider the NMC's Careline. Trauma-informed support can make a real difference.
Keep a short note each time you feel a strong reaction: what happened just before, where you were and how your body felt. Patterns usually emerge.
For most people they ease with time, support and as the case concludes. They may return occasionally, but you can learn to manage them.
