Wednesday, July 17, 2019

Psychiatrists Describe Dangers in Physician ‘Burnout’ Becoming Catchall Term for Emotional Distress

Despite ongoing efforts by health care systems and professional medical organizations to create tools and practices to decrease physician burnout, physician depression and suicide prevention remain “relatively ignored,” wrote psychiatrists Maria A. Oquendo, M.D., Ph.D., Carol A. Bernstein, M.D., and Laurel E. S. Mayer, M.D., in an article appearing today in JAMA Psychiatry.

The authors described several factors that may contribute to the imbalance between attention paid to physician burnout versus major depressive disorder, including the ongoing stigma of mental illness and its treatment: “[T]he term burnout, which indicates a human reaction to something outside oneself, is less stigmatized [than major depressive disorder],” they wrote. This has allowed it “to become a catchall term for emotional distress experienced by physicians.”

Additionally, many symptoms of burnout overlap with symptoms of major depressive disorder (MDD), they noted. “The shifting definition of burnout, in concert with the overlap with psychiatric symptoms, sets the stage for a situation in which burnout can be invoked and a treatable diagnosis missed,” they wrote. “As a result, a physician dutifully completing a burnout screening inventory for self-evaluation, as now recommended by the Accreditation Council for Graduate Medical Education, could easily conclude that she or he has burnout rather than MDD.” Such missed opportunities may prevent or delay treatments, putting the physician in danger.

What can be done to resolve this problem? Oquendo, Bernstein, and Mayer suggested several solutions including screening physicians for depression, anxiety, and substance use disorders when screening for burnout and creating confidential and easily accessible psychiatric services for physicians and trainees.

“Ultimately, the biggest challenge is rolling back the corrosive effects of stigma so that more affected physicians will feel comfortable acknowledging, at least to themselves and their personal physician, that what ails them is a treatable brain disorder and not simply an impossible work situation,” the authors concluded.

Oquendo is a past APA president and a professor and chair of psychiatry at the Perelman School of Medicine at the University of Pennsylvania. Bernstein is a past APA president and vice chair for faculty development at Albert Einstein College of Medicine/Montefiore Medical Center. Mayer is an associate professor of clinical psychiatry at the Columbia University Vagelos College of Physicians and Surgeons.

For more on burnout, including a Psychiatric News series on this topic, see APA’s Well-being and Burnout Resources.

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