Intended for healthcare professionals

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Analysis

Burnout in healthcare: the case for organisational change

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4774 (Published 30 July 2019) Cite this as: BMJ 2019;366:l4774

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Re: Burnout in healthcare: the case for organisational change

Burnout is not a diagnosis, but a normal biologically mediated response to system dysfunction. Individuals push themselves ever harder into high sympathetic drive until, running out of energy and attention, they freeze and eventually fold into parasympathetic defensive withdrawal. In large part as Montgomery and colleagues rightly point out, the dysfunctional drive is external and organisational. However, certain internal factors, amplified and perpetuated by what the refer to as a ‘physician culture that valorises inappropriate self-care and the avoidance of emotionally challenging events’ will make it harder to cope. Therefore while organisations bear a responsibility for mitigating the impact of medicine’s inherent intellectual and emotional challenges, so do medical educators.

The realities of clinical practice, all too often entail serial contact with suffering and extreme emotions, often for long hours, dogged by the ever-present risk and consequence of errors, and where though fix-it solutions are few, expectations are high. This is the uncertain territory we as doctors must occupy, yet it is not one that our medical schools prepare us for. In our experience of developing ‘resilience workshops’, doctors at every level benefit by having insights into stress, self-compassion for their predicament, and skills for recovery and resilience-building. Early signs of burnout are, as Mongomery and colleagues say, red lights on individual and corporate dashboards. Therefore in the stormy waters of our NHS, while we wait for the organisational weather to change, such buoyancy aids should become part of our prevention strategies.

Professor David Peters
Centre for Resilience
University of Westminster

Daghni Rajasingam MA MRCOG
Deputy Director for Postgraduate Medical Education
(Leadership, Quality Improvement and Resilience)
Guys and St Thomas' NHS Foundation Trust.

Competing interests: No competing interests

15 August 2019
David Peters
clinician, academic
Daghni Rajasingam MA MRCOG Deputy Director for Postgraduate Medical Education (Leadership, Quality Improvement and Resilience) Guys and St Thomas' NHS Foundation Trust.
emeritus professor westminster centre for resilience
Westminster Centre for Resilience College of Liberal Arts and Science University of Westminster 115 New Cavendish St London W1W 6UW