Clare Gerada: Understanding burnoutBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1595 (Published 28 April 2020) Cite this as: BMJ 2020;369:m1595
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Identifying and treating colleagues suffering from the vicarious trauma of “normal” medical work is essential but labelling the condition as the essentially non-illness of "Burnout" prevents what would otherwise lead to a requirement for reporting of an occupational disease under RIDDOR (1). Proper Health and Safety investigation would consider methods of reducing risk from the hazard of vicarious trauma that doctors are typically subjected to on a daily basis.
Burn-out is defined in ICD-11 (2) as follows:
“Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
• feelings of energy depletion or exhaustion;
• increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and
• reduced professional efficacy.
Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”
DSM5 (3) is more complex but, in this context a PTSD diagnosis could perhaps be made on the basis of
• Criterion A Stressor (one of)
Indirect exposure to aversive details of the trauma, usually in the course of professional duties
• Criterion B Intrusion Symptoms (one required)
Emotional Distress after exposure to traumatic reminders
• Criterion C avoidance (one required)
Trauma-related thoughts or feeling
• Criterion D negative alterations in cognitions and mood (two required)
Overly negative thoughts and assumptions about oneself or the world
Decreased interest in activities
Difficulty experiencing positive affect
• Criterion E alterations in arousal and reactivity
Irritability or aggression
• Criterion F: Duration (required)
Symptoms last more than 1 month
• Criterion G: functional Significane (required)
Symptoms create distress or unctional impairment (eg occupational)
• Criterion H: exclusion (required)
Symptoms are not due to medication, substance use, or other illness
On the face of it, professional burnout fits the “dissociative specification” of PTSD and so should be the subject not just of withdrawal from the workplace (though that may be needed) but those with the condition should be reassured that their condition is treatable and then offered appropriate evidence based therapy (4).
Should we not now drop the “Burnout” word and consider PTSD as much an occupational disease in doctors as it is in the military.
3. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013
Competing interests: I have with Philip Dutton, a Trauma Psychologist, decided "GazeTherapy" which is based on using the juxtaposition of cranial nerve nuclei with other brainstem structures that have been implicated in trauma and anxiety symptoms. I have an Occupational Medicine business but do not have any clients who are medically qualified.