Richard Smith: A flare up of burnout

Richard SmithThe German speaking world is having a flare up of burnout. The media are full of stories on burnout, and 150 000 school pupils in Austria are said to be burnt out together with “every second doctor.” The annual cost to Austria is supposedly 2.7 billion Euros, and, said Anita Rieder, professor of social medicine in Vienna, it’s a “major topic” that is on “every agenda.” It is, she added, a “common disease” that “can affect anybody.”

Professor Rieder was chairing a session on burnout at the Alpbach forum in the Tyrol, and not a seat was to be had. The audience, mostly doctors, was packed into the hall, and there was huge concern about this epidemic of burnout.

I was sat in the front row and was struck by the double irony that the theme of the conference was “construction and reality” and that I’d earlier delivered a paper on how many “diseases” are social constructs and that maybe we’ve come to a stage where the disease concept is doing more harm than good. The speakers and the audience were very keen that burnout should be recognised as a “proper disease.”

But when, I reflected, did I last hear about burnout in Britain? It struck me that concern about burnout had burnt out, and later one of the experts on burnout from Switzerland told me how she had invited an expert from Britain to a conference and that he was amazed by the size and passion of the audience. “We wouldn’t get seven people to a meeting in London,” he’d said.

There are many competing definitions of burnout, said Beate Schulze, vice-president of the Swiss Expert Network on Burnout, but the one she favoured says that sufferers have three characteristics: they are exhausted by their work; they distance themselves from their organisation, become cynical, and cease to believe in what they are doing; and think that they are no longer good enough at their work. (Interestingly, doctors, whom all agreed to be prime candidates for burnout, tend to have the first two characteristics without the third.) You can see how with such a definition there might be “a lot of it about.”

Dr Schulze asked whether there was an epidemic of burnout and said that the evidence was difficult to interpret because of different definitions and methods and because “burnout is good business,” meaning that some people have a vested interest in pumping up the numbers. We did hear, however, how the Swiss media believes that one in five Swiss and the president of Iran might all have burnout—and how Wittgenstein was a famous sufferer. (The fact that Mahmoud Ahmadinejad may be burnt out is both unsurprising and gratifying.)

Walter Dorner, the president of the Austrian Chamber of Doctors described the dire state of Austrian doctors with half of them in danger of burnout, 20% already burnt out, half of them exhausted at the end of the working day, and a third of them saying that they wouldn’t have become doctors if they had known how awful it was. (All this reminded me of the BMA being called the British Misery Association, and I thought cynically how it probably didn’t apply to the officials and employees of the chamber as all doctors have to belong to what is both a trade union and regulator, a deep conflict of interest.) President Dorner blamed bureaucracy, information technology, patient expectations, lawsuits, long hours, night work, and poor salaries for the high rate of burnout and summed up the plight of doctors as having “high demand and low influence.”

It may come as a surprise to some of the poorer paid workers in Austria to learn of the awful miseries of doctors, but I couldn’t help thinking that President Dorner would have gone down a storm at the BMA’s annual representative meeting, that whingefest where doctors spell out how awful it is to be a doctor, often while trying their hardest to get their children into medical school.

Then we heard from a man who ran a spa where burnout could often be cured (at rather considerable expense, it seemed) and a manager of one the largest supermarket chains in Austria who was hoping to avoid burnout in his employees by keeping the shops open for no more than 72 hours a week (118 hours would not be unusual in Britain).

What to make of all this? Is it reality that there is an epidemic of burnout sweeping through the German speaking world or is it a construction that suits the media, politicians, academics, psychiatrists, doctors, and business? I don’t know, but the short hours of the supermarket made me wonder whether increased competition and reduced security within economies is accompanied by a flare up of burnout. Maybe we in Britain had our flare up as Margaret Thatcher handbagged us whereas similar changes are happening now in Austria. It’s just a theory, a construct.

Richard Smith was the editor of the BMJ until 2004.