Burnout: Is the GMC asking the right questions?

Caffeine and contemplation

Dominique Thompson

Tuesday, 10 April 2018

I read with interest and then concern about the GMC’s plans to ask doctors in training and their trainers about burnout.

One of the key features of burnout in healthcare professionals is loss of empathy or compassion and an increase in cynicism, and this appears to be completely missed by the questions chosen by the GMC from the Copenhagen Burnout Inventory for this exercise. The GMC appears to have focussed almost solely on workload issues, and their impact on personal life/ job satisfaction, but this is a separate and easier to ‘fix’ issue than loss of empathy in my view. Compassion and empathy are, to me, the hallmark of good clinical practice, and when these go patients are as much likely to suffer, albeit differently, as when doctors are tired or overworked. Mistakes may be made, not because of fatigue, but because doctors just don’t care as much. Not deliberately harmed, of course, but harmed through lack of engagement and compassion. As doctors we need to have boundaries, but if we become too ‘emotionally distanced’ from our work it may become difficult to connect with our patients and provide warm, humane and thoughtful care.

Does the GMC not care about this?

Burnout was first identified by a psychologist observing the work of ‘helping’ professionals, i.e. doctors and nurses. The features were later considered to be very similar to depression, and much overlap occurs, and the debate continues about how burnout and depression might differ. The general consensus seems to be that burnout can essentially be treated with rest and recuperative time away, whereas depression requires more formal interventions such as therapy or medication, or both.

For me, in observing my struggling colleagues who appeared to be ‘burning out’, the clearest and most worrying feature was always when they started to become lacking in compassion, and increasingly cynical, towards patients. Workload issues could be tackled together with streamlining of systems, extra manpower in the short-term, time off to sleep and spend time with family. However, as a team we can support someone to feel refreshed and energised once more, but would they recover their ‘caring’ nature?

This is what the GMC needs to be asking about and identifying early, to then providing support as appropriate, whether through psychological therapy, career coaching, or other positive experiences.

I am obviously pleased that the profession as a whole is discussing doctors’ wellbeing more openly, providing national support for GPs in distress and asking about burnout early to allow for earlier intervention, but I would make a plea that we ask about loss of empathy and compassion too, as we tackle workload and exhaustion, as they are the features that define us as dedicated and effective healthcare professionals.

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