WHO lists burnout syndrome in ICD-11: Here's what doctors can do about it
M3 India Newsdesk Aug 30, 2019
As physicians, you may have bad days but are you having too many of those lately? Did a day’s leave make you feel better but the negative feeling didn’t take long to return? Do you find yourself feeling irritated, exhausted, mellow or aggressive most of the time? If you have a ‘yes’ to either of the questions above, you are experiencing a ‘burnout’. If you think that this is not the case with you, do not dismiss it just yet!
WHO identifies burnout as an occupational phenomenon and has added the syndrome in the 11th International Classification of Diseases. Read on to know if you or your colleague is experiencing something similar and why is it important to identify and acknowledge it.
‘Burnout’ as per ICD-11
As per ICD-11, the definition of burnout is described as: “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions, which are:
- Feelings of energy depletion or exhaustion
- Increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job
- Reduced professional efficacy
Burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”
Experiences that can lead to a burnout
An article by the American Medical Association listed common experiences that can spark burnout, as identified by Dr. Mark Linzer, MD, director of the division of general internal medicine at Hennepin County Medical Centre in Minneapolis, who has studied Physician Burnout for long.
- You have a high tolerance to stress.
Dr. Linzer says, “Please don’t ignore the stress, even if you can take it.”
- Your practice is exceptionally chaotic.
- You don’t agree with your boss’ values or leadership.
This means that physicians and the people leading them should have the same values for medicine and patient care. Differences here can cause the physicians to get demotivated and eventually burn out.
- You’re the emotional buffer.
About physicians, Dr. Linzer says that, “We will buffer the patient from our own stressful environment until we can’t take it anymore.”
- Your job constantly interferes with family events.
Dr. Linzer considers work-life interference in one’s own personal time as a common factor for burnout among physicians.
- You lack control over your work schedule and free time.
- You don’t take care of yourself.
As physicians, these experiences may be normal for you, however, if you feel the pressure every day, or find yourself constantly at war with the management or colleagues, you might be experiencing burnout.
The syndrome may affect your mood, making you mellow or aggressive. You may also feel drawn towards means of temporary escape, such as smoking, drinking and the likes. If you can relate to these experiences or anything worse, it is time to acknowledge them.
Increase in burnout rate
The JAMA Network Open recently published a study titled 'Trends and Factors Associated with Physician Burnout at a Multispecialty Academic Faculty Practice Organization' by Marcela G. del Carmen, John Herman, Sandhya Rao, et al. The report highlights the increase in burnout rate among US physicians from 40.6% (as per a similar survey conducted in 2014) to 45.6% in 2017. [1]
The 2017 survey pointed out the following factors resulting in burnout among the participating physicians:
- Increase in administrative tasks and the time spent on them but without adequate resources to complement the work load
- The growing work demand on physicians, which may either not match their interest in the field or bring along a feeling of burden and lack of joy in their practice
- With electronic health records being implemented, the measurement and reporting of quality metrics have become essential but demand more of the physician’s time.
The paper further states that burnout has negative consequences over the physician’s overall wellbeing, his efficacy in patient care and his contribution to the health care system.
Remarks by researchers
A related study, titled Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors, authored by Daniel Tawfik, Jochen Profit, Timothy I. Morgenthaler, et al., was published by Mayo Clinic Proceedings on July 9, 2018. [2] The study aimed to assess the extent of perceived major medical errors in relation to physician burnout, their well-being, and work unit safety grades.
The survey researchers concluded that 55% of the participating physicians had reported burnout and 10% of them also admitted to having made a huge medical mistake in the three months prior to the survey. However, low safety grades in their workplaces were linked to three to four times the odds of medical error. The study concluded that physician burnout is at least equally responsible for medical errors as unsafe medical workplace conditions, if not more.
An article based on the same paper by Tracie White was published on Stanford Medicine News Centre, which stated that the errors and the effect on patients can seriously affect the physician’s state of mind. The article quoted Tait Shanafelt, MD, director of the Stanford WellMD Centre, associate dean of the School of Medicine and co-author of the Mayo Clinic Proceedings paper: “We also know from our previous work that both burnout and medical errors independently double the risk of suicidal thoughts among physicians. This contributes to the higher risk of death by suicide among physicians relative to other professionals.” [3]
An article published in the Harvard Gazette carried a story from a paper titled 'A Crisis in Health Care: A Call to Action on Physician Burnout' by Ashish K. Jha, Andrew R. Iliff, Alain A. Chaoui, et al. The paper terms physician burnout a public health crisis. Addressing one of the major issues. Ashish Jha, co-author and professor at the Harvard Chan School, said, “The growth in poorly designed digital health records and quality metrics has required that physicians spend more and more time on tasks that don’t directly benefit patients, contributing to a growing epidemic of physician burnout.” [4]
What do the IMA and AIIMS have to say?
As per a report published in The Hindu, Indian Medical Association (IMA) states, “They battle stress, strain, depression, career setback, personal tragedies etc., and through it all keep working in a very competitive field that can break even the best.”
Furthermore, the IMA has declared suicide among physicians as a public crisis. It has identified long hours at work, the pressure of saving lives, undergoing challenging medical training, witnessing death and trauma up close as some of the reasons of high levels of stress among physicians.
The All Indian Institute of Medical Sciences (AIIMS) also acknowledges the stress levels of the physicians. In the report, an AIIMS official said that acknowledging that there is a problem is the first step towards fixing it. AIIMS has a system in place to help students facing issues with settling in. It is also looking to set up wellness centres for its doctors.
AIIMS also states that in 2018 itself, six of their doctors had sought admission into the psychiatric ward of their hospital and so, they have taken the matter very seriously, initiating a well-thought out rehabilitation process for their doctors.
What can physicians do to beat burnout?
As per the publication The Hindu, the IMA suggests that physicians and the assisting staff, all should ensure good mental health. As per IMA’s national president Ravi Wankhedkar, “Rest, recreation, need for physical activities should be understood. Also, it is vital to recognise mental strain as early as possible to mitigate damage.”
Whether it is you or your colleagues, the symptoms of burnout can seem so ordinary that you may not give them enough merit. Also, you might be used to ignoring your feelings, so you may not give any weightage to that sinking feeling. However, it is important to watch out for consistent mood swings or a low feeling, anxiety about reporting to work, self-destructive behaviour or other actions that point towards a mental health issue.
It is understandable that doctors find it extremely difficult to seek help in general, let alone reaching out to the management for aid in stress management. However, know that hospitals now understand the seriousness and ramifications of the syndrome, so whether they are prepared with necessary initiatives for their doctors and assisting staff or not, you must at least try and approach them.
Approach the management for solutions or help in handling your difficult-to-manage schedule, providing an extra resource to ease your workload and if the management is equipped to provide psychiatric help, do not shy away from signing up. Speak up about your problems before it engulfs you fully. You are after all a human first!
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