Is Burnout BS?

I’m no epidemiologist, but we all can notice how diseases and their definitions change over time.  Once AIDS was a checklist of various abnormalities that clustered together, then we discovered the HIV virus and eventually treated even those who didn’t yet fit that definition.  There are diseases we know the cause of, can diagnose with reasonable accuracy, and can make predictions about outcomes even if there is no cure, what one might call authentic diseases. And then there’s some that are mere associations of symptoms and signs that are harder to define in a way that doesn’t change with the times and our culture, of which we might never find a unifying cause or be able to predict outcomes or treat. Some of these lose the disease status and become considered part of normality, like the effect on woman of being treated as mere property, formerly called hysteria.    

So what is burnout?  Apparently the modern use of the term has been around for decades, even back when I thought it only meant someone who smoked too much dope.  We didn’t learn it in med school in the old days at least, but the triad definition was already in use: emotional exhaustion, depersonalization, and decreased feelings of accomplishment.  It doesn’t have a page in UTD, but ICD 11 has now included it, subtracting the word “feelings”, ie actual decreased accomplishment, and adding that it must be from employment. If it is an illness, is it a mental illness?  

And what of the outcomes? Can errors, suicide, or quitting be considered deleterious outcomes of a real disease?  Errors can more intuitively be explained by not having time to think, but that’s more likely to be caused by your work environment than by how you feel about it.  Suicide is more likely caused by major depression, which may have overlap with burnout but is certainly not the same thing. Quitting would just be a reasonable response, not pathologic.  

And if it’s a disease, what is the cause?  The treatments usually offered as well as the admonitions to “seek help” seem to point to the idea that we should see it as a either a mental illness or lack of resilience.  But we are as a group amazingly resilient, just look what we put up with in our twenties!  Pamela Wible defines it as the normal response to abuse.  ZDogg among others define it as the response to moral injury.  And a recent survey discussed in my previous post shows doctors and nurses think it’s related to too much work to do in the EHR.  Cause matters, because eliminating the cause makes more sense than any other treatment, and I tend to agree with all three.   Making intelligent and knowledgeable people who have so much to offer humanity pretend they are happy with idiot bosses having them do idiotic things while blocking their ability to do what they know will help is really all three. 

There’s a newly named workplace syndrome or diagnosis that seems to also tie all three together, and it’s called bullshit.

So BS is a form of torture.  Many tolerate it for 40 hours a week, but they are usually in jobs where they have time to do other things at work, or at least relax, and they were probably never idealistic enough to give up their youth and go into serious debt to have a satisfying career.  Maybe burnout is just BS combined with having too much of it to do, or the effect of all that on people who once were idealists?

Bridget Reidy MD

Bridget Reidy is an FP practicing near Victoria, British Columbia who abhors hypocrisy, waste, euphemisms, and useless bureaucrats, ie inauthentic medicine. She was a board certified FP with a certificate of additional qualifications in palliaitive care, no longer because, MOC. She did her residency in rural Marquette Michigan in the eighties, and spent her career mostly in the US in a variety of settings, emergency, urgent care, family practice - including locums on reservations, prisons and medicaid mills, and housecall practice - including work as a hospice medical director. Now she owns and runs a solo cottage industry style family practice, typical of Canadain FP's. She is on the advisory board of The Medical Post, Canada's newsletter for physicians, and a member of BC GP's for reform. 

  11 comments for “Is Burnout BS?

  1. Steve O'
    August 18, 2019 at 12:57 pm

    I do have to admit that the system that I trained in, years ago, was a haven for narcissists. The old days of medicine allowed those who had an affinity for those who enjoy cutting other peoples’ throats. Such people advance by destroying. I saw it throughout my undergraduate training, and it repulsed me so much that I gave up any intent of pursuing the career of medicine. But the university research community was slightly less filthy.
    I hate the way the new system hurts good and innocent people. But the old system was no more humane or decent. One has to look back to the days of Francis Peabody to find the prevalence of humanity in the field of medical education. What is happening is disgusting and unacceptable; but what it was like in the not too distant past was also disgusting.
    Once a society rewards the most aggressive parasites in its midst, that society is doomed.

  2. Vincent
    August 17, 2019 at 5:08 pm

    AMEN

  3. Jesse Lee Belville,PA-C
    August 17, 2019 at 2:50 pm

    IF YOU DO NOT LIKE WHAT YOU ARE DOING, hours, EHR, current practice location, admin BS . Well Change it. As physicians with no bad crap in your record, the World is looking for You. I know one MD, works 9 months a year, wife and Family goes off on Adventure to Europe, Asia ,Greece, . Every year someplace new or to re explore. You Have Choices. Burn out is BS. You Have CHOICES.

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    • Steve O'
      August 17, 2019 at 6:16 pm

      I’m not a Marxist, but read about commodification. That’s what’s happening.

  4. Pat
    August 17, 2019 at 2:31 pm

    “…once…”

    Precisely noted.

  5. Randy
    August 17, 2019 at 2:02 pm

    Good essay. I think the idea that burnout is mainly described by its symptoms as opposed to its cause is accurate.

    When I read about burnout in the media, medical or otherwise, it’s generally described as a condition where my take is that it’s a response or reaction. The focus is usually on managing the response as opposed to minimizing the causes.

    I don’t know that the BS analogy completely fits. I think most doctors believe their job is meaningful, although there are many components within the job that are not – EMR, Press-Ganey surveys, “quality improvement” activities, MIPS, etc. Add to that that there are parts of the job that are inherently and unavoidably difficult emotionally. In a way the best comparison might be to police, first responders, or soldiers. When you also factor in the long years of training, the debt, and the generally high intelligence of physicians it’s a unique combination.

  6. Bill Ameen, MD
    August 17, 2019 at 1:42 pm

    Great post! The more people read about diseases, the more likely they are to think they have the symptoms, like chronic fatigue, fibromyalgia, and, yes, “burnout.” Now that I’m several years removed from having to report to work every day, I can reflect back and ask if I myself was burnt out when I chose to retire. I don’t honestly feel I was, even though I had worked most weekends and holidays my entire career of emergency medicine, urgent care, and family practice. I was employed by a hospital only for the last 4 years. I really didn’t mind the EHR that I had not been able to afford prior to selling my practice. I actually liked most of my patients. No one ever put a gun to my head and told me to go into medicine. If you suffer burnout from something you volunteered for, you went into it uninformed or with different expectations, and you definitely should make changes in your career.

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    • Susan
      August 17, 2019 at 2:00 pm

      What we signed up for and went into informed and with appropriate expectations has so horrifically changed as to be unrecognizable.

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    • Bridget Reidy
      August 18, 2019 at 3:09 pm

      I agree with Susan, but I also like your comment that we tend to “have” what we know about. One part about my thinking on burnout I didn’t include is that it happens in other places with different forces. In Canada we have a lot of autonomy and very little busy work, which is the reason I came, but Canadians docs still claim burn out. It used to puzzle me till I left the East and came to BC where people are extremely self centered and demanding of our time, think we make as much as American docs with our $33-46 visits, and that there’s nothing to be gained from the wisdom of someone with expertise. Similarly, when I first heard of the term burnout being applied to learners, it made no sense to me. Of course we were always just as abused and overworked before this “disease” became known, but we used to expect eventual autonomy and appreciation. Nowadays even learners know that’s not in the cards. Maybe my whole essay is BS and the real cause is patients! Then again, if you redefine it as mere job dissatisfaction, it shouldn’t be surprising that as individuals we each have different reasons. There are so many reasons why the Golden Age of Medicine is gone, but I did get to enjoy some of it and we shouldn’t be blamed for being disappointed and not knowing how much things would change.

      • Pat
        August 18, 2019 at 10:16 pm

        I do believe that patients represent a huge component of burnout. Be they day-laborer or multi-millionaire, I would never treat someone the way I or my coworkers routinely are. The anger at an incomprehensible, corrupt system that is misdirected at physicians and nurses is only tolerable as an alternative to unemployment and bankruptcy.

    • Natalie Newman, MD
      August 18, 2019 at 3:19 pm

      The pursuit of medicine was(and is) a lofty goal. Most physicians entered for the right reasons. Of course we all knew the sacrifices, we had a taste of it when we had to do well in our pre-med courses and prepare for the MCAT while our friends graduated and went on with their lives. I think most docs understand sacrifices are a necessary evil to becoming a physician. However, no one signed up or expected to be abused by a conglomerate. No one signed up or expected to have their education demeaned and devalued and their contributions minimized. I sure as hell did not sign up to become a data entry clerk. It is ludicrous to think anyone would “volunteer” for that s**t. Our goals and expectations were honorable; however, the medical system in which we worked had no such honor. It changed. It has no empathy or compassion. That doesn’t equate to us not loving medicine, we still do. So we have to change the system. And it ain’t easy.

      Doctors are human and suffer from from the flaws of an industry that is incongruent with who we are and how we practice. Does no one any good to be criticized by a colleague who somehow thinks expressing our humanity is a weakness to be overcome or leave a career we love. Utterly ridiculous. There are certainly other options.

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