Burnout recognised as a medical condition for the first time

Evelyn Lewin

28/05/2019 3:13:34 PM

The WHO has confirmed what most health practitioners likely already know.

Stressed doctor
The research has shown the effects of burnout can include cardiovascular disease, musculoskeletal pain, depressive treatment and job dissatisfaction.

‘This is not news to most GPs.’
That is RACGP President Dr Harry Nespolon in response to the fact that, for the first time, the World Health Organization (WHO) has recognised burnout as a medical condition in its International Classification of Diseases (ICD).
‘The fact that they’ve finally given it an official title really doesn’t change the fact that burnout is a significant and real issue for GPs,’ Dr Nespolon told newsGP.
‘It’s certainly something that’s been front of mind for GPs, and people that work with them, for a long time.’
In the new classification, the WHO defines burnout as ‘a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed’. The syndrome is characterised 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
  • Reduced professional efficacy
According to the classification, burnout specifically refers to phenomena in the ‘occupational context and should not be applied to describe experiences in other areas of life’.
The research has shown the effects of burnout can include cardiovascular disease, musculoskeletal pain, depressive treatment and job dissatisfaction.
Dr Nespolon believes burnout is common among GPs for a number of reasons.
He said GPs expend a lot of ‘emotional energy’ each day being empathetic to patients, while also facing a ‘whole lot’ of system issues, such as when trying to admit a patient into hospital.
‘Every day is a struggle of trying to do the best for your patient,’ he said.
‘GPs are becoming more and more advocates for their patients and the system is getting harder for them to advocate on behalf of their patients … so that puts doctors at higher risk [of burnout].
‘It certainly hasn’t been helped by government policy, especially when it comes to financing. So not only do you have to see patients, but you’re worried about a whole lot of other things apart from seeing that patient in front of you.’

Burning out as a GP doesn’t just impact the doctor, Dr Nespolon said, but also their patients.
‘It’s well recognised that part of burnout is that patients don’t get the absolute best care they could possibly get, so it is a serious issue,’ he said.

‘It is a serious issue,’ RACGP President Dr Harry Nespolon said of doctors and the risk of burnout.

GP Dr Vicki Kotsirilos is well aware of the effects of burnout, having experienced it during her internship.
‘The long hours and overnight shift work fatigued me,’ she told newsGP.
‘Also, there was some bullying experienced by some of the nursing staff. I felt burnt out by the end of the year and confused whether I was really happy with medicine.’
Dr Kotsirilos took the year off after internship. She returned to work as a hospital resident the following year, but could feel herself becoming burnt out again.
She credits joining a meditation group and partaking in regular yoga with helping her avoid further burnout.
Nowadays, Dr Kotsirilos likes to wake at 5.00 am and start each day by meditating in her garden and walking in nature. She also works part-time, takes time to meditate during her lunchbreak, eats healthily and goes to bed early.
‘This routine of self-care keeps me healthy physically and psychologically,’ she said.
Long-time GP Dr Libby Hindmarsh has never experienced burnout herself, but came ‘very close’. When she could feel herself falling down a slippery slope, she decided to ‘work hard at not reaching that point,’ so she could continue her long-term career as a GP.
For Dr Hindmarsh, weekly supervision sessions in her practice have helped her avoid this condition. She believes taking regular holidays and exercising most days has also helped.
‘My mantra is, “You cannot give to others [patients] out of an emptiness in yourself”,’ Dr Hindmarsh told newsGP.
Associate Professor Bob Davis believes having a number of changes in his career – including working as a rural GP, doing a university-based job with private work, and now working part-time in the hospital sector – has helped him avoid burnout.
‘Speaking to some of my GP friends, I think being locked into the same job can lead to burnout,’ he told newsGP.
‘It helps to have a focus or passion in what you do.’
Of course, taking steps to avoid burnout can be easier said than done.
‘One of the ways of dealing with it is to take some time off, but due to the financial situations a lot of GPs are finding themselves in, it makes it difficult to do that,’ Dr Nespolon said.
Dr Nespolon said the ‘catch 22’ is that GPs at greatest risk of burnout are those who have the least amount of leave, or ability to work less.
‘That’s the irony,’ he said.
Dr Nespolon hopes the WHO recognising burnout as a medical condition will lead to governmental ‘policy changes that can have significant effects on the wellbeing of our GP workforce’.
The negative health effects of burnout were explored in a systematic review of prospective studies, published in PLOS ONE in 2017.
The review, based on well-conducted and well-reported studies, found that cardiovascular diseases, musculoskeletal pain, depressive symptoms, psychotropic and antidepressant treatment, job dissatisfaction and absenteeism are ‘consistent effects’ of burnout.
The updated WHO ICD list, ICD-11, was drafted last year and approved on 26 May. It takes effect in January 2022.

burnout WHO World Health Organization

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Dr Rod Street   28/05/2019 5:50:15 PM

Good luck getting Workcover and the insurance companies to accept it!

Dr Arshad Merchant   29/05/2019 6:22:43 AM

We talk about physicians burnout and decision fatigue but is RACGP has any say?? I propose a better pay and fixed patient face to face consultation and an hour admin work... the above scenario is high in bulk billing practices where GPs are working as slave to cooperate owners and this needs to stop

Surendar Advani   29/05/2019 10:17:22 AM

How to manage burnout?

Mileham Hayes   29/05/2019 10:58:43 AM

For minor trauma the public gets "Grief Counselling" but, by contrast, clinicians who see almost daily horrors are, somehow, meant to be immune, such as with the death of a very dear patient at 3am this morning. We can't even claim PTSD. That’s OK but now we have AHPRA which encourages every nutter or hysteric to make a complaint and will even provide an interpreter and write the complaint paid for by the doctor's taxes. Medicare promises to audit you. It’s open season.
Doctors in the U.S. experience burnout at twice the rate of other workers, citing long hours, fear of being sued, time-consuming medical records and dealing with a growing bureaucracy. Sounds familiar? The economic impacts of burnout cost the U.S. $4.6 billion p.a. according to a new study published.
The Noble Profession has been demeaned and denigrated with Pharmacists, Nurses et al all playing “doctors”: “They seek power without responsibility – the prerogative of the harlot for centuries” and so, avoid burnout.

Dr Mattias Faldt   29/05/2019 2:24:43 PM

I have to agree with Dr Hayes above.

Nadia   30/05/2019 7:49:27 AM

I agree with everything said .Add daily unrealistic expectations , verbal abuse from patients and families...and more ...
Add personal challenges in my case being single parent first generation in Australia glad my children stay away from Health industry all together ...

Ula   31/05/2019 7:30:39 PM

We are educated to be "Service Providers" "Health Care Givers". Current community expectations fostered by political forces (mostly foes to the welfare of the medical profession - lawyers and charlatans ) and medical administrators pressured to get as much bang for their buck. Neither the community nor the administrators factor that all of us have a life outside of our career and work and do not allow for a personal life to co-exist with making a full and adequate living as well as feeling we have lived up to a professional expectation. Eventually pretending we don't causes us the most damage. Eventually we are forced to mend damages to relationships, grieve over losses of family members or friends. Except failure to be the perfect doctor "anytime, anywhere, all the time".
I define burn out as the first point where I was not able to meat the unrealistic standards of expectation that is an endlessly changing goal post such that eventually everyone in the game will fail.

WARREN MENESES   13/06/2019 1:25:13 AM

Burnout is real, there is no exemption even to those who have good coping mechanism. The thing is we need to recognize it at early stage before it does further catastrophe to our overall well being. I used to work in a rural GP setting where you do the clinic, do 24 hours on call in the urgent care, admit patients and visit nursing home. I try to be a super hero to the detriment of my mental well being. I thought I do not have a choice but I did have which I do not know before. The support is lacking to GPs who are working in the rural setting. The RACGP should address this. If the GP is supported and equipped a lot will keep working in the rural area. I believe "burn out" syndrome is more prevalent to country GP and be supported more.

Ravi Bundellu   15/06/2019 11:03:40 AM

GP’s start working at young age full of enthusiasm to help improve health of their parents
They gradually learn that improving Heath does not necessarily mean satisfaction to customer
Behind every presenting complaint is a person
There are many personalities which respond in different ways to the same situation
Hence a GP has the formidable task of tailoring his approach differently for each patient
Most of the patients respect their GP’s knowledge and follow their advise
A small but formidable minority test all the reserves at the bottom of GP tank
Those are the drains which cause some of burn outs
GP’sneed to tread very carefully when they realise a demanding patient and do their uttermost to protect themselves against such “Assault “
Only time and patience will help