Table 2 Illustrative quotations for themes and sub-themes

Medical identity intact/It will never happen to me

“I think there is a huge psychological barrier, well, I found there was, in terms of admitting you are struggling with things, and again it might just be me personally, but there’s a certain amount of pride involved in not wanting to admit that you are struggling and not wanting to accept what’s going on” (PPT7)

“It’s hard for a doctor to say. They’re used to helping people, so actually it’s really hard to say I might need some help” (PPT 2)

Denial of disrupted medical identity

“And I remember them saying so flippantly, almost as a tick-box exercise,” “You don’t need to see a counsellor, do you?” And actually, I really did … If I had had the support …right at the beginning, this hell is going to be prevented (PPT 8)

“And also it’s very much a culture within the NHS that you are at work, because if you are not at work it means somebody else has double the work…If you don’t do it, it means your colleague has to do it and nobody likes to be in that position. Nobody likes to put their colleague in that position.” (PPT3)

Being on the edge: accepting help

“I felt a small amount of resentment or something, or the inference that I was a problematic… I know I was causing them headaches because I was stressed and causing issues … The inference is that you were incompetent or that you were… Do you know what I mean? That you would cause a problem clinically, that you were unsafe or. And so I felt a little bit resentful of that implication from the website even I knew that I wasn’t the case” (PPT 5).

“I think it’s difficult to accept that sometimes you can be a patient and you can have something happen that means that you need extra help, and you don’t want to be seen by your colleagues or your managers as someone who can’t cope because you’re meant to be able to cope in emergency and difficult situations” (PPT7)

“The other thing that I was a bit conscious about is when you… When I went for the meeting with the PSU. It’s done up in the Deanery House … there are quite a few people who are based up there from [speciality]… And so I… And there were all these like formal like annual reviews going on that are held there at different times of year for training and so I was also quite conscious of like well what am I going to say if I bump into someone I know?” (PPT5)

Role of PSU in ‘recovery’ process/Making sense of their story

“I felt that I was being supported and not judged, and they made that very clear. I found it really helpful…because until then, you felt that you were the only that was going through a difficult time and that was a failure on your part, and that was part of where I was mental state as well, thinking that everything that was negative against, it was all your fault and everyone else was fine” (PPT2)

“I remember her (PSU staff member) saying to me,” “I can’t believe you’ve dealt with this all by yourself up until this point.” And I think actually just seeing someone almost visibly shocked by what I was telling her, just made me realise that no I’m not being pathetic … “Gosh, she almost can’t believe what I’m telling her.” And it was just the first time that I had actually thought, “Okay, this isn’t me just falling apart and losing it, because I’m pathetic, it’s actually because I’ve been through quite a difficult situation.” “So that was another pivotal moment I think” (PPT 8)

Role of PSU in ‘recovery’ process: Focussing on their own health

“I was off work and it’s the first time I’ve ever been off work, and you’re constantly feeling bad about it and you don’t know what everyone thinks, and you don’t know how long you should be off. And it’s really difficult and I think [PSU staff member] was very reassuring and saying,” “It sounds like the right thing you’re off, and do not rush back,” and you know, to kind of say it’s okay that you’re off work. “So that’s what I think was a really important thing” (PPT 6)

Role of PSU in ‘recovery’ process: Understanding that they are not alone

“So to go there and realise that of course you weren’t the only one, and many people have been here you are and have now gone on and are living and doing what they want to do, and not restricted by that. Just making you feel that it was the norm, because certainly as medics you kind of feel that that shouldn’t happen to you, which is ridiculous, but that’s how you feel. It’s [the NHS] very much a culture of man up and just get on with things. It [the PSU] felt the opposite of that attitude. It felt that actually you are a human, just like everyone else, this can happen, and here we are to support you, this is what we can do, and we want you to be the best that you can be. And so it was really encouraging and supportive, I felt” (PPT2)

Repaired identity/Coming back from the edge

“I mean they very much have your best interests at heart and really don’t want to lose you, you know. Kept making a big thing about you being, you know, how the Deanery wouldn’t want to lose you from the training programme and that it wasn’t going to be detrimental, and really they just want to try and help you get back on track really”. (PPT 6)

Different ways to be a doctor

“I think he fully understood how I was feeling [about on-calls] and he actually thought about cover there and then, and so immediately I just felt better because that was one thing I had actually been really worried about” (PPT1).

“support helped in that the attitude was helpful in that some people do it this way, other people do it that way and that’s acceptable” PPT2).

Breaking the cycle

“that they stay in contact even after things have got better is a real positive because if you feel that things are even starting to head down the same sort of road again then you don’t feel like you’re going backwards because you’re already … you’re still in touch with them, so even though nothing is said in these emails you still feel like you’re in the system somehow” (PPT 1)

“It’s people who have been there done that who end up being mentors to help other people. That’s really encouraging, particularly if there’s a risk of feeling like you’re the only one. But to see someone who is on the other side is much better, it’s really helpful” (PPT 2)

“I just know if I was a registrar listening to all the things that I’ve had to go through I would have learnt so much and I wish I had known all of this before I went through this” (PPT 8).