Burnout and fatigue among hospital doctors have left many without compassion for patients, and putting their care and safety at risk, a medical expert has warned.
The working conditions are so bad one doctor spent his lunch time crying in the toilet and needing psychological and psychiatric help.
A conference, Compassion in Healthcare, is being organised to help medical professionals manage burnout - and learn how to care again.
Doctor James Shand, 30, graduated from the University of Auckland in 2012 with dreams of becoming a renal specialist.
But work at two New Zealand hospitals - which he did not want to name - left him severely burnt out and needing time off from the profession for one and a half years.
Shand described the hospitals as having "chronic and toxic" work environments.
"At lunch time everyday, I would go to the cafe and wouldn't want to talk to anybody else, sit in the toilets and cry and eat lunch by myself, and then go back and do my job like nothing was going on," he said.
"Then I'd come home and just go to bed, and I did that for a couple of weeks and my fiancee pointed out that probably wasn't normal."
He said the lack of support and staffing meant working "ridiculous hours" and left a sense of guilt among doctors taking any time off.
"We all go into medicine wanting to be good people ... but you go to the hospital and there's just not quite enough of us," he said.
"Over time, everybody gets more stressed, more angry and more defensive of their time and you end up in this chronic, toxic environment.
"If you asked the junior doctors, most of us wouldn't be proud of the way we treat each other."
Shand said patients were being seen as "extra work" and in some cases each new referral was resented.
"When you have more work than you can do in a day, every new referral sort of becomes almost an extra assault and instead of seeing it as a human who needs treatment and help you kind of resent the person," he said.
"Doctors at hospital become very snarky with each other ... very rude to GPs and other staff members, and we sort of take out our frustration of the workload on each other."
He had to give up on renal medicine and only recently returned to work as a part-time general practitioner in a Manurewa clinic.
"It is sad having to quit your dream, but it is the more pragmatic solution," Shand said.
Dr Tony Fernando, senior lecturer at the University of Auckland School of Medicine, said Shand's experience was the norm rather than the exception.
A survey by the Association of Salaried Medical Specialists, which represents 90 per cent of doctors and dentists working in New Zealand hospitals, found half of all public hospital specialists to be suffering from high levels of burnout.
"We're finding that doctors, clinicians, nurses are losing compassion and are unable to care any more," Fernando said.
"Not just because they're weak or tired, but it's because of a system issue. If the system is broken, people will lose compassion."
Fernando, a psychiatrist and sleep specialist, has been conducting research into doctor burnout in New Zealand and its effects for the past five years.
His research has found that rosters "can be horrendous" and scheduling of work for junior doctors and staff is often unsustainable.
"There's not enough doctors, not enough beds and doctors and nurses are the ones freaking out about where to place the patients," he said.
"If doctors, nurses and staff are threatened by the lack of support and overwork, their brain would not want to care.
"They see patients as work or just 'assaulting' them again, so care is compromised."
A University of Manchester and Keele University study last month found that doctors with burnout were twice as likely to make mistakes such as incorrect diagnoses or prescriptions.
The study analysed studies on clinician burnout and found it could jeopardise patient care.
"I do not have the statistics of medical mistakes due to doctor fatigue, but I can say for certain that clinician burnout compromises patient safety," he said.
Fernando said an increasing number of doctors were emotionally exhausted, and had symptoms of depression.
The Compassion in Healthcare Conference in March next year - the first of its kind here - is aimed at helping medical professionals manage burnout.
"We need to learn to see patients as people who can care for and putting patients in the forefront," he said.
"Many doctors are becoming fatigued from our work and we need to learn how to care for ourselves and rediscover compassion again in medicine."