Mental Health in Medicine: The Burnout Breakdown

Simone Biles, Naomi Osaka, Michael Phelps -- these three athletes, besides being the best in their sport, have each taken a step back from their game to focus on their mental health. It is, in part, due to notable figures such as these that mental health is taking a front seat in the discussion on what it means to be healthy and why wellness is important for both the body and the mind. But it’s not just athletes who need to care for themselves.


Physicians are at an increased risk for mental health challenges and burnout is a common factor leading to the development of depression and suicidal ideation [1]. This means physicians need to be vigilant in spotting signs of burnout in themselves and those they work alongside. We wanted to shed light on burnout, to bring awareness to signs and symptoms one may experience during all stages of burnout so you know what to look for in yourself and others. But we hope this blog post inspires you to do more than just look for burnout. We hope you act, take the necessary steps to alleviate burnout or help someone else do the same. Throughout this post, we posit some ideas on how to do so. We want to be clear that the burnout we are speaking of is the specific occupational phenomena identified by the World Health Organization (WHO). While personal factors are no doubt a large part of burnout, for the purpose of this post we are focusing on burnout as it relates to the workplace.


Burnout defined

So what exactly is burnout? Burnout is a syndrome of exhaustion, depersonalization, and diminishing accomplishment -- it is a state of being chronically tired, cynical, and discouraged [2].


According to WHO, burnout is defined in ICD-11 as follows:

Burnout 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.


Mental health is health

Mental health is health. This means, just as we have to put in work to stay physically healthy, we also have to put in work to stay mentally healthy. The mind and body are connected. This fact is one reason why we find the stigma surrounding mental health so frustrating. You seek help when you are physically unwell. So why should the mind be any different?


There are many internal and external factors at play in the development of burnout. Here are just a handful [1]:


External Factors

  • Problems of leadership and collaboration

  • Lack of organizational influence

  • Poor internal communication

  • Administrative constraints

  • Lack of positive feedback


Internal Factors

  • Perfectionism

  • Always wanting to please other people

  • Suppressing own needs

  • Work as only meaningful activity

  • Work as substitute for social life


Stages and symptoms of burnout

The good news about burnout (yes, there’s good news) is it happens in stages [1]. You won’t wake up one day and suddenly be burnt out. It’s a progression, and along the progression are symptoms that can help you identify burnout. Symptoms of burnout vary by the degree of burnout. This lends to the importance of early detection of these symptoms. Take a look at the stages below. Do you identify with any of these symptoms? Think about those around you. Have you noticed any of these in a colleague?


Stage 1: Honeymoon Phase

  • Job satisfaction

  • Accepting responsibility

  • Sustained energy levels

  • Commitment to the job

  • High productivity levels


Stage 2: Onset of Stress

  • Inability to focus

  • Avoidance of decision making

  • Reduced sleep quality

  • Neglect of personal needs

  • Anxiety


Stage 3: Chronic Stress

  • Persistent tiredness

  • Feeling pressured

  • Social withdrawal

  • Resentfulness

  • Cynical attitude


Stage 4: Burnout

  • Obsession with problems

  • Self-doubt

  • Pessimistic outlook

  • Chronic headaches

  • Behavioral changes


Stage 5: Habitual Burnout

  • Chronic sadness

  • Chronic mental fatigue

  • Chronic physical fatigue

  • Depression


Who suffers as a result of burnout?

A June 2019 study in Annals of Internal Medicine calculated that physician burnout costs the healthcare industry $4.6 billion per year. What’s staggering about that number is what it means for patients. As you’ll read, one of the main areas affected by burnout is patient care [4].


Patient Care

  • Lower care quality

  • Medical Errors

  • Longer recovery times

  • Lower patient satisfaction


Healthcare System

  • Reduced physician productivity

  • Increased physician turnover

  • Less patient access

  • Increased costs


Physician Health

  • Substance abuse

  • Depression/suicidal ideation

  • Poor self-care

  • Motor vehicle crashes


In addition, here is a great example of how the mind and body are connected. Burnout seems to be associated with musculoskeletal diseases among women and with cardiovascular diseases among men. Other studies have suggested that chronic burnout might be a risk factor for the onset of type 2 diabetes and high cholesterol [1]. This is why we say mental health is health. Burnout can affect us on a cellular level. It’s serious, and we hope some of the information we’ve provided helps you understand and identify burnout in yourself or someone you know.


Putting the brakes on burnout

One of the main external factors leading to burnout is the workplace environment in which one works [2], so much so that Maslach et al reported that oftentimes burnout in an individual says more about the organization in which one works [2]. We encourage you to take an honest look at your workplace environment. If you are a leader, are you providing positive feedback to your employees? Is workload distributed equally? As an employee, do you see processes that need to be improved? Do you feel appreciated? How is communication among colleagues? If you are experiencing burnout due to your workplace environment, it may appear that nothing can be done. But there are things in your control that you can do, like taking an honest look at your workload or evaluating the quality of communication among colleagues and with leadership. Once you’ve done that, you can begin to look for where you can make improvements. And they’ll need to be incremental improvements. You didn’t burnout in a day, and you’re not going to bounce back from burnout in a day.


We hope the awareness of burnout will inspire you to take action to identify burnout in yourself or someone you work with. Once identified, you can begin taking those incremental steps toward better wellness for yourself which ultimately helps the patients you serve.


Built on the vision of better patient outcomes, Instapath was founded in 2017 by engineers and scientists to enable patients to immediately know their cancer diagnosis. Our team made it our mission to develop fast and easy digital pathology technology so diagnosis can be made in minutes instead of days. To learn more about Instapath and our technology, visit https://instapathbio.com/ or contact us at info@instapathbio.com.


References


1. De Hert S. Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies. Local Reg Anesth. 2020;13:171-183. Published 2020 Oct 28. doi:10.2147/LRA.S240564


2. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 3rd ed. Palo Alto, CA: Consulting Psychologists Press; 1996.


3. Kaschka WP, Korczak D, Broich K. Burnout: a fashionable diagnosis. Dtsch Arztebl Int. 2011 Nov;108(46):781-7. doi: 10.3238/arztebl.2011.0781. Epub 2011 Nov 18. PMID: 22163259; PMCID: PMC3230825.


4. West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med. 2018 Jun;283(6):516-529. doi: 10.1111/joim.12752. Epub 2018 Mar 24. PMID: 29505159.