Defining burnout Is burnout the correct term to use? To move forward and advocate for change, it is imperative that we come to a consensus and unite on a standardized term. May 1, 2022SundayMay 2022 issue Burnout Vania Manipod, DO Vania Manipod, DO, is the editor in chief of The DO and an AOA board-certified psychiatrist practicing in Orange County, California. Contact Dr. Manipod
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I believe the definition that is most appropriate is “Compassionate Fatigue Syndrome” (CFS). The entire healthcare system depends on the compassion of healthcare providers to support their system regardless of physical or mental difficulties. As a practicing neonatologist for over 40 yrs, I would never recommend relying on their “system” for your mental health. If they can replace you with a cheaper version, they will. The best analogy I have heard for CFS is the game of Jenga. We all have just so many pieces. With a death, unexpected results, malpractice lawsuit, personal crisis, a piece may be removed or destabilized. When too many pieces are moved, the whole tower falls. How can you stabilize your pieces? Time off. At least once a year, take a 3 week period to do nothing! How can you do that, spend less, remove that stressor. I truly believe 95% of us went to medical school because of a “calling” to help people. When you start working, spending, getting on the system hamster wheel, that is easy to forget. Being able to do what we have been trained to do is a huge blessing, but the”system will take advantage of your “calling”. By accepting responsibility for your own health, you become a better doctor, spouse and parent! May. 12, 2022, at 7:41 am Reply
Thank you for working to bring awareness to this serious problem for individuals and society at large. It is affecting health care workers of all types and in most settings. I’m not optimistic that it will get better soon or ever as there are powerful forces at many levels of the way our society operates and prioritizes allocation of resources. One of the layers that wasn’t really mentioned is the increase in level of severity and complexity that patients present with at the same time that staffing and time squeezes are being implemented to increase corporate profits. Mental health among almost all Americans is fraying for various reasons, and that complicates and slows meaningful improvement. My main thought with this well-presented article is that I see the need to continue to have two distinct terms. The moral injury and human rights violations sound vague and hard to describe but do point out the broader causes in systemic parts of our society. Physicians in particular face a long existing barrier here as people and institutions have little sympathy as our eventual monetary rewards justify anything that happens to us during training and working. But to me as an individual those terms do nothing to describe how I feel and how my life is affected. I personally had to take a break after one and a half years of treating patients during Covidf to rest, restore, and regain my compassion due to burnout. Those terms give me no direction to pursue for my own health and wellness May. 12, 2022, at 10:54 am Reply
I served as Chair of the Committee on Health and Mental Health Policy while in the Missouri House of Representatives from 2010-2018. During that time I introduced and secured passage of the Show Me Compassionate Medical Education Act which called on all six of our medical schools in Missouri to join forces and study the root causes of depression and suicide among med students and residents. Sadly, the robust multi-center studies I envisioned have not been undertaken. For several years I have refused to use the term “Burnout” for the reasons well described in this article, and instead have used the term “ Health Care System Abuse Syndrome” which more aptly describes what is happening to our Med students, residents and practicing physicians. May. 12, 2022, at 9:45 pm Reply
I do not like my employers talking to me about my personal life. In the name of burnout prevention the boss who has authority over me 8-5 now can ask me how much time I spend at the gym. She gets to judge my leisure choices. She gets to judge my diet and she can (and does) reflect these judgements on my evaluation. What if I don’t want to ride a bike at a mandatory (uncompensated) “burnout reduction” weekend? What if would rather watch Netflix and chill. What if I don’t want to advocate for social change as part of “burnout reduction”. I see the whole burnout or “moral injury” or anything else you want to call it this month as nothing more than little dictators expanding the universe of their power over my life. I don’t need your opinions about my personal life. I get defensive about such things. May. 13, 2022, at 7:06 am Reply
Thank you Dr. Manipod, for your insights and your work with physicians. When I coach physicians on almost any topic, burnout inevitably comes up. Though I agree the term is imperfect, and most of us do not like the term, it is a start. Dr. Kernon Manion in his work on the issue “The Matrix of Clinician Distress” (https://physicianinterrupted.substack.com/p/matrix-clinician-distress-part1?s=r) describes how important it is to determine what the physician is actually dealing with: burnout, compassion fatigue, depression, or moral injury, to then be able to find true solutions for them. We and the house of medicine have much work to do to find solutions to this ongoing dilemma. Stay well and thanks to all of you for doing the jobs you do. May. 16, 2022, at 6:15 pm Reply