The Scottish Government and health boards across the country have struggled with many challenges over the last year, according to Dr Brian Keighley, chairman of the British Medical Association (BMA) in Scotland.
These include the ageing population, rising expectations from patients and their families about care and the expectation that levels of care should be the same at weekends as well as during the working week.
Dr Keighley used his New Year message to argue that changes to the health service should be made by evolution, not revolution.
Any reforms should be made through a system-wide approach to the NHS and should only be brought in once there is a clear indication that they will produce sustainable benefit, he said.
The Government and NHS managers need to "propose less low-value process changes that disrupt health services" and "focus on more consolidation and evolution of existing human and other resources and services".
Politicians should "be transparent with the public that, despite political ambitions, there is a limit to the financial resources available" for the NHS.
Dr Keighley spoke of the "resultant pressure" from "operating within financial constraints" and that "reports of stress and burnout amongst all grades of clinical staff are now emerging across the service".
Dr Keighley, who ends his term as BMA's Scottish chairman in the summer, noted the "steady reduction of hospital beds, contrary to medical advice, and without a wider whole-system approach".
The Herald has launched a series of articles asking if Scottish hospitals have enough beds and staff to cope with the rising number of elderly patients.
The newspaper is campaigning for a review of hospital and community capacity to ensure that safe and dignified care is provided.