Thank you for your thoughtful response on this topic and to my editorial, Professors Iliffe and Manthorpe. I note your points that we do not know what burnout is, as long as studies are operationalising it differently, and that the effect of burnout on patient care is not clear.
In relation to the first point, a review led by Professor Colin West (1) indicates that physician burnout demonstrates associations with self-reported medical errors, perceived quality of care, and patient safety metrics. For example, mortality (using standardised mortality ratios) can be predicted by emotional exhaustion (2) which is a key component of burnout according to Maslach et al. (3). In terms of physician health, the review (1) identifies associations between burnout and physician depression, alcohol abuse, suicidal ideation and motor vehicle accidents. There is no evidence of causality and such results merit further investigation but do suggest that burnout is relevant to both patient and physician health.
Regarding the solutions to burnout and their effectiveness, again I would draw attention to a further review led by Professor West which is very informative about the effectiveness of different types of solutions to physician burnout (4). This review demonstrates that burnout interventions do show reductions in overall burnout scores and scores on two of the main components of burnout (emotional exhaustion and depersonalisation) when examining changes in an intervention group with a control or comparison group. I do agree that we need to ensure that studies focused on burnout should operationalise it in a way that uses established measures to allow for robust results and replicability. There are established tools for measuring general work/professional burnout such as the Maslach Burnout Inventory (3). West et al.'s review on interventions to reduce physician burnout (4) included only studies which had used a suitable and established burnout inventory.
References:
1. West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med 2018;283: 516–529.
2. Welp A, Meier LL, Manser T. Emotional exhaustion and workload predict clinician-rated and objective patient safety. Frontiers in Psychology. 2015;5:1573.
3. Maslach C, Jackson SE, Leiter MP. (2017). Maslach Burnout Inventory Manual, 4th Edition. Menlo Park, CA: Mind Garden.
4. West, CP, Dyrbye, LN, Erwin, P J, & Shanafelt, TD. (2016). Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. The Lancet, 388(10057), 2272-2281.
Rapid Response:
Re: Brief history of burnout
Thank you for your thoughtful response on this topic and to my editorial, Professors Iliffe and Manthorpe. I note your points that we do not know what burnout is, as long as studies are operationalising it differently, and that the effect of burnout on patient care is not clear.
In relation to the first point, a review led by Professor Colin West (1) indicates that physician burnout demonstrates associations with self-reported medical errors, perceived quality of care, and patient safety metrics. For example, mortality (using standardised mortality ratios) can be predicted by emotional exhaustion (2) which is a key component of burnout according to Maslach et al. (3). In terms of physician health, the review (1) identifies associations between burnout and physician depression, alcohol abuse, suicidal ideation and motor vehicle accidents. There is no evidence of causality and such results merit further investigation but do suggest that burnout is relevant to both patient and physician health.
Regarding the solutions to burnout and their effectiveness, again I would draw attention to a further review led by Professor West which is very informative about the effectiveness of different types of solutions to physician burnout (4). This review demonstrates that burnout interventions do show reductions in overall burnout scores and scores on two of the main components of burnout (emotional exhaustion and depersonalisation) when examining changes in an intervention group with a control or comparison group. I do agree that we need to ensure that studies focused on burnout should operationalise it in a way that uses established measures to allow for robust results and replicability. There are established tools for measuring general work/professional burnout such as the Maslach Burnout Inventory (3). West et al.'s review on interventions to reduce physician burnout (4) included only studies which had used a suitable and established burnout inventory.
References:
1. West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med 2018;283: 516–529.
2. Welp A, Meier LL, Manser T. Emotional exhaustion and workload predict clinician-rated and objective patient safety. Frontiers in Psychology. 2015;5:1573.
3. Maslach C, Jackson SE, Leiter MP. (2017). Maslach Burnout Inventory Manual, 4th Edition. Menlo Park, CA: Mind Garden.
4. West, CP, Dyrbye, LN, Erwin, P J, & Shanafelt, TD. (2016). Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. The Lancet, 388(10057), 2272-2281.
Competing interests: No competing interests