Who Farted: Stigma Stinks (Diagnostic Clarity Needed to Distinguish Physician Burnout & Depression)

“Erroneously labeling a physician’s distress as burnout may prevent or delay appropriate treatment of MDD, a serious and sometimes life-threatening mental disorder,(1)”

            This particular article then goes on to describe overlapping symptoms and clinical features between burnout and major depressive disorder, lack of diagnostic clarity on burnout, and stigma associated with having depression.Burnout is a syndrome defined by the 3 principal components of emotional exhaustion, depersonalization, and diminished feelings of personal accomplishment.  Major depressive disorder, pervades all aspects of a patient’s life, whereas burnout is a distinct work-related syndrome. Burnout is most likely to occur in jobs that require extensive care of other people.(2)

This article impacted me most with describing the stigma aspect of depression. It’s true. We’re quick to call it burn out when in fact it could be depression. That’s the point of this article. I’d hypothesize that chronic burnout could lead to depression. That would be a nice study project. There is so much overlap between the two. However, when we can explain something with less stigmatizing terms it’s easier for all to accept, but it’s dangerous. It prevents help from being obtained. “As long as stigma and shame are associated with psychiatric disorders, and we have a convenient, ready-made psychosocial formulation to explain away distress in the medical profession, there is a risk that psychiatric illnesses will be less likely to be acknowledged, recognized and treated appropriately…” (1). 


  1. https://www.healio.com/psychiatry/depression/news/online/%7Bbdbd71cd-c041-47ad-9f83-63b6dc8ec118%7D/diagnostic-clarity-needed-to-distinguish-physician-burnout-depression
  2. Chopra SS, Sotile WM, Sotile MO. Physician Burnout. JAMA. 2004;291(5):633. doi:10.1001/jama.291.5.633 https://jamanetwork.com/journals/jama/article-abstract/198131#REF-JMS0204-3-1-1

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Robert Duprey MD

Robert P. Duprey Jr studied medicine as a 2nd career medical student who went to medical school in his 40’s after honorable discharge and ‘retirement’ from 25 years in the US Military (USCG & US Army). He was a registered nurse (RN) with specialty training as a psychiatric RN in the US Army for 15 years. During this time he also became a Master’s level psychotherapist in 2002. While on US Army active duty he also became a Psychiatric Nurse Practitioner while working full time in 2011. He served as a Psych NP on active duty, to include a combat tour in Iraq, until his ‘retirement’ in 2014 and moved to Philippines with his 3 children. At this time he started medical school overseas at Oceania University of Medicine based out of Samoa accredited by Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU). He continued to work as a Psych NP throughout medical school to support his children and to not have to take out loans for medical school tuition. Originally from Rhode Island, he completed medical school clerkship rotations throughout the USA with a graduation in May 2019 earning the esteemed credential of MD. He has successfully completed USMLE Steps 1, 2CS, and 2CK. He will take Step 3 this September as he applies for Psychiatry Residency. Having been and RN, NP and now MD, he is a believer of Physician led multidisciplinary healthcare teams 

  3 comments for “Who Farted: Stigma Stinks (Diagnostic Clarity Needed to Distinguish Physician Burnout & Depression)

  1. Bridget Reidy
    August 6, 2019 at 1:29 pm

    But burnout has a stigma. The powers that be keep telling us it’s our fault and we should engage in more self care as the presumed cure. The effect of burnout is also considered settled science, increased mistakes. Otherwise would they even care how we feel? Any doctor at presumed risk of increased mistakes is of course worthy of stigma, at least from patients and bosses. (I disagree that it’s the burnout that causes the mistakes though, more on this as a future post.)

  2. Pat
    July 30, 2019 at 3:30 pm

    I think you understate the danger. “Burnout” will be used by employers to disguise depression, making discipline, forced leave of absence, or firing easier mechanisms to deal with problem docs.

    Likewise, genuine mental illness exacerbated by working in this industry may be passed over as “burnout,” and the sufferers know they had better stay under the state medical board radar.

  3. Mark O'Brien
    July 30, 2019 at 2:38 pm

    I would rathet have burnout on my application for privledges than depression. Burnout is acceptable. Depression follows you everywhere as a stigma. Subtle denials of participation. Shame.

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