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4 January

How an NHS doctor burns out

My practice is out of control. I lie awake at night worrying about how a mistake could result in a patient with a cancer being missed.

By Peter Neville

I finish dictating the letter on the last patient in my afternoon out-patient clinic. It is a quarter to five and I’m on call for emergency medicine this evening. The first thing I do is ring the medical registrar on call.

I walk down to the A&E department. All of the rooms are full and all of the beds occupied – mostly by patients who were admitted the day before. In the waiting area patients and relatives are sitting desultorily in the metal chairs, some standing. The junior doctor identifies the cases that need review. The first is an elderly woman. She is slumped in her chair and is clearly confused. The junior explains that she is dehydrated and septic; she’s been started on antibiotics.

She will be in that chair all night. The hospital is full. It may take a few hours or several days to find a bed. It depends on who is going home (or dying). She is unlikely to get home within a month, although she will be recovered within a few days. There is nowhere to examine her with dignity. I can’t find a nurse to help me – they are too busy.

I continue my round. The cases are all above 80 years old, often with chronic illnesses and disabilities. Most are not able to look after themselves. Often there is no treatment needed – they just need bed and meals, and care provision in their homes, but this can take weeks to sort. Because of this they won’t be able to go home easily.

I return to my office. There is a pile of 100 new GP referrals. Most need an endoscopy, a clinic appointment, or both. I judge who is at the greatest risk and allocate accordingly. The concerning patients should get their test within a few weeks. The others could wait years.

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One of my colleagues is off sick. It means I have to cancel endoscopy lists to cover his ward work. We have all been off with Covid over the past two years, some of us repeatedly.

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My practice is out of control. A mistake with vetting the letters could result in a patient with a cancer being missed. I lie awake at night worrying about this risk my patients are exposed to. If I get one case wrong somebody could die. It is a heavy burden.

This continues. The pressure has been continuous since the release of lockdown. A “winter crisis” is now 12 months long. We used to have a respite in summer – that has gone. It is too much to take.

At home, I retreat into myself. I’m withdrawn, irritable. I feel tired all day. The world is coloured darkly.

It is my wife who tells me that I need help. Of course it is. So I ring my clinical director. She is sympathetic and clear. I think she has been there herself. “You need at least a month off,” she says. “Take it easy. Watch a boxed set. I don’t want to see you until October.”

She is right. I spend two weeks doing nothing. The depth of my exhaustion amazes me. I can barely get out of bed in the morning. But slowly my energy returns. I start to walk for longer. To enjoy the sun.

I will have to protect myself when I go back. To take a step back. To do my job as best as I can. I can’t do this again. I consider changing job but I know it is the same everywhere. I have to learn to detach. I have to. This is not my fault.

[See also: The truth about the worst NHS crisis]

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