Practicing medicine is not easy; it’s challenging, demanding, stressful and requires dedication and sacrifice. All their professional lives, doctors strive to take care of their patients. They confront death almost every day and have to deal with the emotional trauma of losing patients despite best efforts. This comes at a great cost to their health and well being. The incidence of physician burnout has been rapidly rising in recent years. The ongoing Covid-19 pandemic has only aggravated the problem.

Recognising the pressing and perceived need to improve clinician well-being, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Society of Cardiology (ESC) and the World Heart Federation (WHF) have come out with a joint opinion addressing this very crucial subject and have called for “global action in health care reform, research and policy development to address clinician well-being”. Strategies that health care organizations and specialty associations can adopt to reduce burnout have also been described.

The opinion paper has described clinician well-being“as experiencing satisfaction and engagement with work, while also having a feeling of professional fulfillment and a sense of meaning in work”.Burnout, on the other hand, has been described “as an occupational phenomenon that is defined as emotional exhaustion, depersonalization, and a sense of low personal accomplishment in a perceived stressful work environment”. According to the authors, absence of burnout does not mean well-being. Burn out has been identified as one amongst the negative components along the spectrum of well being. It can occur simultaneously with other negative mental health conditions such as anxiety and depression.

Burnout hurts the doctor both personally as well as professionally. At the personal level, burnout may manifest as alcohol abuse, substance use, dysfunctional relationships, depression and even suicide. Professionally, burnout is associated with higher rates of medical errors, lower quality of care, decreased patient satisfaction, lack of enthusiasm for work, cynicism, low sense of personal accomplishment and sometimes, early retirement.

Workload and job demands, control over work, work-life balance, alignment of organizational and individual values, social support at work and meaning in work are some of the key drivers of burnout. In this regard, the Opinion paper states that “women are under-represented in cardiology and may have more stressors contributing to burnout due to lack of career promotion, inequalities in resources (financial), and disparities in mentorship while working in environments that lack diversity, equity, inclusion, and belonging”.

If left unaddressed, these stressors hamper delivery of high quality patient care. Hence, they need to be identified and dealt with to prevent clinician burnout and increase work efficiency. Burnout therefore can be considered as a standard or criterion to measure and monitor, whereas clinician well-being is the goal.

The delivery of healthcare has altered over the years with care centered on the patient, making him an equal partner in clinical decision making in all matters regarding treatment.

In view of this, a new term “Triple Aim” was introduced in 2008 to optimize health system performance (Health Aff (Millwood). May-Jun 2008;27(3):759-69).  It had three goals: improving the individual experience of care (including quality and satisfaction), improving the health of populations and reducing the per capita cost of healthcare.

But, this approach did not take into account the healthcare workers who were actually engaged in the delivery of healthcare. Their well-being has a direct impact on the effectiveness of healthcare. It is vital to the achievement of the goals of Triple Aim. Hence, a new term “Quadraple Aim” was coined in 2014 to acknowledge the role of doctors, nurses and other healthcare providers. A fourth aim was added “improving the work life of health care clinicians and staff” (Ann Fam Med.  2014;12(6):573-6).

In 2019, the World Health Organisation (WHO) added burn-out in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon, but not as a medical condition.

The ICD-11 defined burn out as “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 ones job; and
• reduced professional efficacy.

 Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”

The joint opinion has been published simultaneously in the flagship journals of all four organizations: Journal of the American College of Cardiology, Circulation, European Heart Journal and Global Heart.

(Source: ACC News Release July 13, 2021; WHO May 28, 2019; Mehta LS, et al. J Am Coll Cardiol. Jul 7;S0735-1097(21)04809-9, doi: 10.1016/j.jacc.2021.04.043)

Dr Shashank R Joshi,

Consultant Endocrinologist, Mumbai