Ralph Drosten, MD
Professor Department of Medical Imaging University of Arizona Creighton University Medical School
The term “burnout” dates as far back as 1974. Coined by psychologist Herbert J. Freudenberger in a Journal of Social Issues article entitled “Staff Burn-out,” he described the phenomenon based upon his own experiences working with volunteers at a free clinic in New York City. Freudenberger observed that dedicated workers in this profession were becoming emotionally exhausted, cynical, and less effective—a state he dubbed “burn-out.” This publication marked one of the earliest formal discussions of burnout as a psychological syndrome, particularly among health care and social service professionals.
On May 28, 2019, burnout first appeared in the World Health Organization’s (WHO) 11th Revision of the International Classification of Diseases (ICD-11)—as an occupational phenomenon, however. Highlighting its relevance to health care workers, the ICD-11 filed burnout under “factors influencing health status or contact with health services,” but stopped short of classifying it as a disease. Although burnout is still not classified as a medical condition, in its definition of burnout as a syndrome, the ICD-11 identified three key components that contribute to chronic stress associated with work:
- Feelings of energy depletion or exhaustion
- Depersonalization, feeling negative and cynical
- Reduced professional efficacy
Distress during medical school and residency can lead to burnout— which, in turn, can result in negative consequences as a working physician. Prevalent in medical students (28%–45%), residents (27%–75%, though specialty dependent), and in practicing physicians (63%), burnout’s psychological distress and physical symptoms impact both work performance and patient safety.
Specific contributors of said burnout include the following: time demands, lack of control, work planning and organization, as well as inherently difficult job situations and interpersonal relationships.
Fortunately, there are several workplace interventions for mentors to mitigate burnout with in-training physicians, such as wellness workshops, workload modifications (e.g., increased diversity of work duties), and better stress management education or appropriate emotional intelligence training.
As individuals, we have our own behavioral interventions to make: meditation, counseling, etc. Social interventions matter, too, especially when promoting our professional relationships. We can’t forget the importance of exercise and other physical activity either.
If not addressed, the risks of burnout are myriad. In addition to increased cardiovascular disease and inflammatory biomarkers, burnout elevates rates of depression and suicidal ideation. Thankfully, plans and attempts in burnout states do tend to decline with recovery.
Importantly, clinician depersonalization is associated with lower patient satisfaction and longer post discharge patient recovery time, so we must be able to identify key physical/psychological symptoms and associated elements of burnout—in ourselves and in others:
Physical symptoms
- Insomnia
- Change in appetite
- Fatigue
- Colds or flu
- Headaches
- Gastrointestinal distress
Psychological symptoms
- Low or irritable mood
- Cynicism
- Decreased concentration
- Can negatively affect productivity and rapport
Additional elements
- Daydreaming
- Procrastination
- Increased alcohol or drug use