Burned out, but what does it all mean?

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Burnout among clinicians is a troubling international trend, but the profession may be attempting to treat it without understanding it adequately, say experts calling for caution and further research. In one of two research articles published on 18 September in JAMA, researchers set out to identify the international prevalence of burnout in a systematic review, but found such substantial variation in burnout definitions, assessment methods and study quality that no conclusions could be drawn.

The analysis of 182 studies from 45 countries found that most of the studies (85.7%) had used the Maslach Burnout Inventory, which measures three dimensions of burnout: emotional exhaustion, depersonalisation and diminished personal accomplishment. However, overall the researchers identified 142 unique definitions for meeting burnout criteria across all included studies.

They found overall burnout prevalence ranging from 0% to 80.5%.

In a second article, a study from the United States of more than 3500 resident physicians, researchers found that close to half of the participants (45%) reported symptoms of burnout, with about 14% reporting that they regretted their career choice.

An editorial accompanying the two articles stated that something “important and worrisome” was happening to clinician wellbeing. The editorialists wrote that the clinician has become the patient, but the health profession has started to act on the patient’s symptom before there is any actual understanding of its pathophysiology, origins, consequences, and effective approaches to prevention and treatment.

Michael Baigent, Professor of Psychiatry at Flinders University, said the term burnout was often inappropriately applied as a dichotomous concept. “Researchers tend to suggest that [clinicians] are burnt out or they are not, but the concept of burnout was never intended to be thought of in that way,” Professor Baigent said. “It’s more a term that should represent a spectrum, capturing people who have few symptoms of burnout through to people who have a lot.”

He said burnout was not a diagnosis or a syndrome. “It’s really a description of a set of feelings in their workplace,” he said. “It’s supposed to capture [the way a clinician feels] when their work becomes overwhelming, whether that’s due to the volume of work or the characteristics of the work. Essentially, it’s a measurement of the match between the person and the work they are doing at the time. So, it’s a very subjective measure.”

Professor Baigent said the challenges in establishing the international prevalence of burnout were not surprising, considering the vast differences between health systems across the globe. Professor Baigent said Australia’s work climate was so different to that in the US that many concerns raised in the US cohort study were unlikely to apply here.

He also said technology had often increased the time it took to see a patient. “There are endless systemic risk management [tasks] that seem very relevant to administrators, perhaps, but less relevant to the clinical care of the patient.”

Professor Baigent said there was much interest and concern among clinicians about burnout, and Australia needed to develop a more coordinated approach to reducing burnout. “The existing approaches are rather piecemeal and vary from place to place,” he said. “There is a shared responsibility between workplaces and [clinicians] to try and reduce burnout. I don’t think people need to be hysterical or alarmed about it, but if we are thinking that burnout is a risk factor for mental illness, it is certainly worth doing what we can to minimise it.”

Professor Baigent acknowledged the many hurdles in tackling a problem that varied enormously. “Burnout varies not only from country to country but also from state to state, and even department to department,” he said. “But there are workplace and cultural strategies that can be put in place to alleviate it.”

Adapted from an article originally in MJA Insight