In the JournalsPerspective

Diagnostic clarity needed to distinguish physician burnout, depression

Maria Oquendo, MD
Maria Oquendo

Although emphasis has been put on combatting physician burnout, physician depression remains largely ignored, according to a viewpoint published in JAMA Psychiatry.

This could be due to overlapping symptoms and clinical features between burnout and major depressive disorder, as well as ongoing stigma of mental illness that make diagnosis and getting treatment difficult, Maria Oquendo, MD, PhD, from University of Pennsylvania Perelman School of Medicine, and colleagues wrote.

“Erroneously labeling a physician’s distress as burnout may prevent or delay appropriate treatment of MDD, a serious and sometimes life-threatening mental disorder,” they wrote. “Burnout is situation specific and driven by a demanding work environment coupled with insufficient resources. Depression, in contrast, is a disorder with well-defined diagnostic criteria and, importantly, may occur context free or as a response to a stressor.”

Not only do many symptoms of burnout overlap with those of major depression — like exhaustion and depersonalization — but the definition of burnout is constantly shifting, making it challenging to diagnose, according to the paper.

Image of burnout 
Source: Adobe Stock

“This current lack of diagnostic clarity has important ramifications. To better understand the association between burnout and MDD and distinguish one from the other, it is essential to develop tools that could aid in the conduct of a strict differential process to determine the source of the symptom profile,” Oquendo and colleagues wrote.

In addition, burnout is less stigmatized than mental illness because it indicates a human reaction to something outside oneself and thus may allow it to become a “catchall term for emotional distress,” the researchers explained.

“As long as stigma and shame are associated with psychiatric disorders, and we have a convenient, ready-made psychosocial formulation to explain away distress in the medical profession, there is a risk that psychiatric illnesses will be less likely to be acknowledged, recognized and treated appropriately,” Oquendo and colleagues wrote.

However, the researchers noted that completing brief, evidence-based screening for depression, anxiety and substance use disorders can help differentiate psychiatric diagnoses and burnout. Easy access to confidential psychiatric services for physicians via web-based platforms or telemedicine may also reduce the risk of not receiving the proper diagnosis and treatment.

“Ultimately, the biggest challenge is rolling back the corrosive effects of stigma so that more affected physicians will feel comfortable acknowledging, at least to themselves and their personal physician, that what ails them is a treatable brain disorder and not simply an impossible work situation,” they concluded. – by Savannah Demko

Disclosure: Oquendo reports royalties from Research Foundation for Mental Hygiene and her family owns stock in Bristol-Myers Squibb. Please see the study for all other authors’ relevant financial disclosures.

Maria Oquendo, MD
Maria Oquendo

Although emphasis has been put on combatting physician burnout, physician depression remains largely ignored, according to a viewpoint published in JAMA Psychiatry.

This could be due to overlapping symptoms and clinical features between burnout and major depressive disorder, as well as ongoing stigma of mental illness that make diagnosis and getting treatment difficult, Maria Oquendo, MD, PhD, from University of Pennsylvania Perelman School of Medicine, and colleagues wrote.

“Erroneously labeling a physician’s distress as burnout may prevent or delay appropriate treatment of MDD, a serious and sometimes life-threatening mental disorder,” they wrote. “Burnout is situation specific and driven by a demanding work environment coupled with insufficient resources. Depression, in contrast, is a disorder with well-defined diagnostic criteria and, importantly, may occur context free or as a response to a stressor.”

Not only do many symptoms of burnout overlap with those of major depression — like exhaustion and depersonalization — but the definition of burnout is constantly shifting, making it challenging to diagnose, according to the paper.

Image of burnout 
Source: Adobe Stock

“This current lack of diagnostic clarity has important ramifications. To better understand the association between burnout and MDD and distinguish one from the other, it is essential to develop tools that could aid in the conduct of a strict differential process to determine the source of the symptom profile,” Oquendo and colleagues wrote.

In addition, burnout is less stigmatized than mental illness because it indicates a human reaction to something outside oneself and thus may allow it to become a “catchall term for emotional distress,” the researchers explained.

“As long as stigma and shame are associated with psychiatric disorders, and we have a convenient, ready-made psychosocial formulation to explain away distress in the medical profession, there is a risk that psychiatric illnesses will be less likely to be acknowledged, recognized and treated appropriately,” Oquendo and colleagues wrote.

However, the researchers noted that completing brief, evidence-based screening for depression, anxiety and substance use disorders can help differentiate psychiatric diagnoses and burnout. Easy access to confidential psychiatric services for physicians via web-based platforms or telemedicine may also reduce the risk of not receiving the proper diagnosis and treatment.

“Ultimately, the biggest challenge is rolling back the corrosive effects of stigma so that more affected physicians will feel comfortable acknowledging, at least to themselves and their personal physician, that what ails them is a treatable brain disorder and not simply an impossible work situation,” they concluded. – by Savannah Demko

Disclosure: Oquendo reports royalties from Research Foundation for Mental Hygiene and her family owns stock in Bristol-Myers Squibb. Please see the study for all other authors’ relevant financial disclosures.

    Perspective
    Louise B. Andrew

    Louise B. Andrew

    Although any reasonable person should be in favor of diagnostic accuracy, there is a very real danger given current trends in the Medical Regulatory Therapeutic Complex that a physician who admits to even a remote history of depression will be regarded as currently disabled and, in contravention of the American’s with Disabilities Act (ADA), subjected by Physician Health Programs or PHPs (under the imprimatur of medical boards) to intrusive Fitness for Duty examinations NOT narrowly tailored to determine whether they can perform their occupation with or without reasonable accommodation, or constitute a "direct threat"; and are all too often coerced into treatment for substance use that is either nonexistent, not problematic, or not proven using acceptable diagnostic criteria.

    So, if physicians who have mild depression are willing to seek help for burnout, and this is a safer way for them to get support without being dragged through coerced actions in contravention of the ADA and often including inappropriate rehab, I personally can see no harm in it.

    For more information:

    www.jpands.org/vol24no2/emmons.pdf

    www.linkedin.com/pulse/word-getting-out-indiscriminately-applied-new-louise-b-andrew

    www.MDMentor.com

    www.PhysicianDepression.com

    www.williamgoren.com/blog/2019/07/13/medical-licensing-boards-physician-health-programs-ada-compliance

    • Louise B. Andrew, MD, JD
    • Emergency medicine physician in Port Angeles, Washington
      Founder and Principal consultant
      MDMentor

    Disclosures: Andrew reports no relevant financial disclosures.

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