Burnout among doctorsBMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3360 (Published 14 July 2017) Cite this as: BMJ 2017;358:j3360
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Burnout has been defined as a work-induced syndrome combining emotional exhaustion, depersonalisation, and a sense of reduced personal accomplishment. In their editorial, Prs Lemaire and Wallace  provide us with an overview of the issue of burnout among doctors. According to these authors, despite heterogeneity in how burnout has been conceived of and assessed in past research, the overall evidence suggests that burnout has reached epidemic levels among physicians. In my estimation, the ‘burnout epidemic view’, although widely relayed in medical journals, is unsubstantiated.
Because there are no diagnostic criteria for burnout, the prevalence of burnout among physicians (or in any other occupational group) cannot be estimated . As pointed out elsewhere, the spotlighted estimates of physician burnout prevalence rely on categorisation criteria that are (a) clinically and theoretically arbitrary, (b) malleable at convenience, and (c) potentially over-inclusive in view of what full-blown burnout has been assumed to be [3, 4]. Such research practices are eminently problematic and leave the ‘burnout epidemic view’ without any valid or reliable basis. Worryingly, the nosological blur surrounding burnout persists for more than 40 years, thus showing strong inertia. Considering that even the ability of burnout measures to specifically assess work-induced suffering is open to question [3, 5-7], it may be time to discuss the very use of the burnout construct in occupational health research.
Given the major problems affecting burnout research, and the well-established overlap of burnout with depression [2, 8], a resource-saving strategy may be to focus on job-related depression rather than burnout. By contrast with burnout, depressive disorders, under their various forms, are diagnosable . Consequently, their prevalence can be accurately estimated. Methods for etiologically linking depression to work stress are available, in both research and clinical settings [2, 9]. Just as burnout, depression can be (a) examined from both a social and an individual standpoint  and (b) relevantly approached dimensionally (i.e., on a continuum, as a process) . Regarding the often-raised issue of stigma, it is noteworthy that there is no clear evidence that the burnout label is currently less stigmatizing than the depression label [11, 12]. Interestingly, in a recent interview-based survey (N = 1,600), about eight of ten participants considered work stress a possible cause of depression—the study sample was representative of the general adult population of France in terms of place of residence, gender, age, and family status . Such findings suggest that social representations of depression may be changing favourably among the Occidental public. All in all, focusing on job-related depression may boost research advance and allow us to more effectively protect doctors’ health in the future.
1. Lemaire JB, Wallace JE. Burnout among doctors. BMJ 2017;358:j3360. doi:10.1136/bmj.j3360
2. Bianchi R, Schonfeld IS, Vandel P, Laurent E. On the depressive nature of the “burnout syndrome”: a clarification. Eur Psychiatry 2017;41:109-110. doi:10.1016/j.eurpsy.2016.10.008
3. Bianchi R, Schonfeld IS, Laurent E. Can we trust burnout research? Ann Oncol in press. doi:10.1093/annonc/mdx267
4. Bianchi R, Schonfeld IS, Laurent E. Physician burnout is better conceptualised as depression. Lancet 2017;389:1397-1398. doi:10.1016/S0140-6736(17)30897-8
5. Hakanen JJ, Bakker AB. Born and bred to burn out: a life-course view and reflections on job burnout. J Occup Health Psychol 2017;22:354-364. doi:10.1037/ocp0000053
6. Dyrbye LN, Thomas MR, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, Shanafelt TD. Personal life events and medical student burnout: a multicenter study. Acad Med 2006;81:374-384. doi:10.1097/00001888-200604000-00010
7. Verweij H, van der Heijden FM, van Hooff ML, Prins JT, Lagro-Janssen AL, van Ravesteijn H, Speckens AE. The contribution of work characteristics, home characteristics and gender to burnout in medical residents. Adv Health Sci Educ Theory Pract in press. doi:10.1007/s10459-016-9710-9
8. Bianchi R, Schonfeld IS, Laurent E. Burnout or depression: both individual and social issue. Lancet 2017;390:230. doi:10.1016/S0140-6736(17)31606-9
9. Rydmark I, Wahlberg K, Ghatan PH, Modell S, Nygren A, Ingvar M, Asberg M, Heilig M. Neuroendocrine, cognitive and structural imaging characteristics of women on longterm sickleave with job stress-induced depression. Biol Psychiatry 2006;60:867-873. doi:10.1016/j.biopsych.2006.04.029
10. Haslam N, Holland E, Kuppens P. Categories versus dimensions in personality and psychopathology: a quantitative review of taxometric research. Psychol Med 2012;42:903-920. doi:10.1017/S0033291711001966
11. Bianchi R, Verkuilen J, Brisson R, Schonfeld IS, Laurent E. Burnout and depression: label-related stigma, help-seeking, and syndrome overlap. Psychiatry Res 2016;245:91-98. doi:10.1016/j.psychres.2016.08.025
12. Dyrbye LN, Eacker A, Durning SJ, Brazeau C, Moutier C, Massie FS, Satele D, Sloan JA, Shanafelt TD. The impact of stigma and personal experiences on the help-seeking behaviors of medical students with burnout. Acad Med 2015;90:961-969. doi:10.1097/acm.0000000000000655
13. Angermeyer MC, Millier A, Remuzat C, Refai T, Toumi M. Attitudes and beliefs of the French public about schizophrenia and major depression: results from a vignette-based population survey. BMC Psychiatry 2013;13:313. doi:10.1186/1471-244x-13-313
Competing interests: No competing interests
Physicians who reflexively blame themselves or their patients for poor clinical outcomes are overlooking other possibilities. While it is true that some physicians make mistakes and that some patients don’t cooperate, it is equally true that healthcare is imperfect, and that some modalities simply don’t work. This is why physicians don’t enjoy better health than their patients. So disappointed or disaffected physicians and patients should learn to question the underlying assumptions and science of healthcare.
Competing interests: No competing interests