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).
REFERENCES:
- https://www.healio.com/psychiatry/depression/news/online/%7Bbdbd71cd-c041-47ad-9f83-63b6dc8ec118%7D/diagnostic-clarity-needed-to-distinguish-physician-burnout-depression
- 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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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.)
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.
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.