The Paperwork or the Patient: The Impossible Choice Breaking South Africa’s Doctors

He faces over forty patients a day, trains the next generation of doctors, and carries the weight of life-and-death decisions. Yet, in the quiet moments between emergencies, his greatest adversary isn’t a medical complicationit’s a mountain of paperwork. This is the daily reality for a senior gynaecologist at a major Gauteng public hospital, who speaks anonymously of the conditions pushing him, and countless others, toward the exit.

“I am drowning in patients and paperwork. But, if I don’t do the paperwork, I run the risk of not getting paid,” he explains. This bureaucratic trap defines his exhaustion. Attend to the pile of forms, and the waiting patients suffer. Attend to the patients, and you sabotage your own income and the hospital’s administrative compliance. It’s a lose-lose scenario played out daily in understaffed wards.

The Crushing Weight Beyond the Stethoscope

The paperwork is just the visible symptom of a deeper sickness within the system. He lists the failures: critical equipment that arrives late or not at all, a single salary that doesn’t reflect brutal overtime, and a chronic lack of support staff. The contrast with the private sector is stark and demoralising. “At private hospitals, you have all the equipment that you need and they pay well; they are also organised.”

This environment breeds a specific kind of trauma. Doctors are trained for high-stakes care but are forced to operate in a context of scarcity. The result is moral distressknowing exactly what a patient needs but being unable to provide it consistently due to systemic failures. “Losing a mother or a baby despite your best efforts leaves a lasting psychological imprint,” he admits.

A Life Lived on Edge

The cost isn’t confined to the hospital. The emotional exhaustion, the relentless night calls, and the constant state of high alert spill over, poisoning life at home. “Many trainee specialists struggle to maintain healthy family relationships due to excessive hours, frequent calls and emotional fatigue. There is very little time to decompress.”

He describes a pervasive “feeling of being on edge even when off duty,” where basic self-care and personal relationships become casualties of the job. It’s a portrait of a profession pushed to its psychological breaking point.

The Exodus and Its Cost

This testimony isn’t just a complaint; it’s a warning siren. It explains the accelerating exodus of specialists from the public sectora brain drain that directly undermines ambitious projects like the National Health Insurance (NHI). How can you build a universal, quality healthcare system when the very experts needed to run it are burnt out and leaving?

The doctor’s story lays bare the human infrastructure crisis behind the headlines. It’s not just about budgets and policies; it’s about the individual breaking point of the people expected to hold the system together. Until the paperwork is streamlined, the equipment is reliable, and the doctors are truly supported, the haemorrhage of talentand the suffering it causeswill only continue. The patient is not just the person in the bed; the entire public health system is in critical condition.