Not 'Burnout,' Not Moral Injury--Human Rights Violations

Pamela L. Wible, MD

Disclosures

March 20, 2019

In This Article

What Are Doctors Really Suffering From?

Republished with permission from Pamela Wible, MD

Burnout is a slang word for end-stage drug addiction, first used on the streets of inner-city America in the early 1970s. During that time, psychologist Herbert Freudenberger volunteered at a New York City free clinic treating addiction. He overhead the term and used it to describe himself and clinic staff in a 1974 article on staff burnout detailing long-term physical and psychological job stress.

He then authored a book on burnout in overachievers and another on burnout in women, further popularizing the slang word which seeped into common lexicon. Burnout was no longer limited to Americans overdosing in back alleys. Now housewives and high achievers and anyone stressed at work suffered from burnout too.

"Physician burnout" first appears on my PubMed literature review in American Medical News in July 1981. It is unclear to me who first applied the term to doctors. What is clear to me—is that despite medicine's obsession with burnout for nearly four decades—the epidemic of physician cynicism, exhaustion, and despair is worsening.

So why are physicians experiencing physical and mental collapse from overwork? Psychiatrists define burnout as a job-related dysphoria in an individual without major psychopathy—meaning, you're normal; your job is killing you.

Meanwhile, physician burnout books and breathing exercises are offered by burnout coaches on every corner. Curious why physician burnout is on the rise amid the plethora of burnout programs, I asked a physician burnout coach, "Don't you think all your 'burnout' breathing exercises and EMR workarounds just prolong the agony for physicians in toxic working conditions?"

He replied, "Yes."

Since that 2015 conversation, I've been debunking burnout as a victim-blaming buzzword that prolongs physician agony by avoiding the real issue leading to physician despair. So what's the real issue? Enter Drs. Wendy Dean and Simon Talbot with their landmark 2018 article, Physicians Aren't 'Burning Out.' They're Suffering From Moral Injury.

In it they explain:

The concept of burnout resonates poorly with physicians: it suggests a failure of resourcefulness and resilience, traits that most physicians have finely honed during decades of intense training and demanding work… Physicians are the canaries in the health care coal mine, and they are killing themselves at alarming rates (twice that of active duty military members), signaling something is desperately wrong with the system…The simple solution of establishing physician wellness programs or hiring corporate wellness officers won't solve the problem. Nor will pushing the solution onto [physicians] by switching them to team-based care; creating flexible schedules and float pools for [physician] emergencies; getting physicians to practice mindfulness, meditation, and relaxation techniques or participate in cognitive-behavior therapy and resilience training.

Yes. Thank you. Exactly.

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