The clinic is running late. My last patient walks in. Her scan report, printed in front of me – bad news. The cancer has grown. I’m experienced at this, I take it slowly. I use the “right” words. She crumples, her eyes fill. The specialist nurse reaches out, takes her hand. In this maelstrom of intense emotion, I feel … nothing. No tears, no heartbreak. I gently explain the next steps, desperately hoping she cannot detect the emptiness behind my words.

This is burnout. A deadening of emotion, a feeling of detachment. I recognise it in myself. I hear it in my colleague’s dark humour, or another doctor wondering aloud how many people’s day she has ruined. Over half of young oncologists working in northern Europe exhibit signs of burnout, a strikingly high number. What causes this level of burnout in young, talented, empathetic doctors?

What is now the hardest part of my job? Apologising, every day, for what is beyond my control. Sorry, your CT scan is delayed. Sorry, you didn’t get your pain relief yet. Sorry, your procedure is cancelled today. Sorry, that’s the earliest date we can get. Sorry, for making you wait, when every precious minute is numbered, ticking by too fast to endure an overstretched system.

Austerity has driven this patched together system, this veneer of healthcare. Minimum time slots are given to see patients with complex needs, who deserve to be treated as individuals. If we run over, we’re inefficient. If we try to restructure our bookings, management ask why we are not working at full capacity. None of us can constantly function at full capacity – the humanity is removed, stolen from our patients and drained from their doctors.

The harmful consequences are yet to be fully appreciated. Physician burnout is associated with increased levels of medical error. Evidence suggests that burnt-out doctors do not make more medical errors, pointing, instead, to the contribution of a pressured, error-prone working environment to burnout.

Doubtless, patient care suffers in other ways when a doctor is exhausted, emotionally detached: there may be a lack of connection, a sense of being cared for, of being heard. Being listened to is of such key importance in the care of a patient – if that is lost, pushed out by tightened appointment times, overstressed staff, the cost of burnout is beyond estimation.

Not only patients but doctors, too, are treated as numbers on a page. Move them from A to B, question their use of every 15 minutes of the working day, expect them to work above and beyond yet penalise them if they dare to document this. The prevailing culture of “I worked every hour, so will you” doesn’t fit with an increasingly diverse workforce who value life outside work. The shocking number of physician suicides indicates a culture and system that dramatically fails to value individual doctors.

Yet the answer, we are told, is resilience. Fix the doctors, get them to manage the workload. That the workload is not manageable is not addressed. An epidemic of burnout has not driven critical appraisal of the system, but instead a focus on the perceived deficiency of character in doctors.

And, yes, physicians will walk that tightrope for a time, carefully balanced, eyes straight ahead, feet gripping the rope. Until the pressures pile up – late again for the crèche run, a bullying colleague who copes by offloading, a quickly made decision that proves to be incorrect, a patient crying at the end of an overbooked clinic. The rope wobbles, the crowds gasp. The feet stumble, falter, then recover and continue. The pressures don’t stop. A service stretched too thin. The fault lies not in the ability to balance but in the rope. The rope moves unpredictably, tautens then loosens, always expecting more. Eventually the most resilient tightrope walker falls, too exhausted to continue, too burnt out to care.

This piece won the Royal College of Physicians Teale Essay prize for writing on Resilience, austerity and the NHS

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