Compassion fatigue is as damaging to a doctor’s health as to a patient’s

Medical training is a process of toughening up: take iron that’s vulnerable to rust, add carbon and make steel. That’s the hope. In a large university lecture hall, I remember a consultant standing in front of a PowerPoint slide showing two triangles, one widening to its base, the other tapering to a point. They represented how our clinical knowledge would expand with time, while our compassion would very probably diminish. It was a warning, but one delivered with a tone of inevitability. As a student I deeply resented this idea, but also worried it might prove necessary for survival.

Doctors and their patients are surprised when training’s protection proves not to be that of an alloy but rather a metal paint that can be scratched and worn away. Joanna Cannon realised in her first year of hospital work that her stethoscope was no ‘talisman’ against a breakdown, but rather a ‘risk factor’. Despite the traditional ideal of the unruffled physician, doctors are often overwhelmed by the interplay of their personal lives and professional encounters. ‘Burn out is an unlikely phrase,’ Cannon writes, ‘because it implies the effects are loud and obvious, raging like a fire for everyone to see.’ For her, it was a slow and silent corrosion.

Cannon started medical school in her thirties, ambitious to become a psychiatrist, having left school at 15 with only one O-level. She was the ‘wild card’ in her year. There are two kinds of doctor, she was told: white coats (who live for the science) and cardigans (who love the people). Cannon identified as a thoroughbred cardigan.