A GP Writes : The Burn-out Syndrome

Burn-out syndrome is a state of severe physical, mental, and emotional exhaustion caused by mental fatigue or stress arising from feeling overwhelmed and/or out of control in a working environment. Since 2019, it has appeared in the International Classification of Diseases (ICD-11) as a problem associated with employment or unemployment.

Burn-out is defined in ICD-11 as follows:

“Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

1. Feelings of energy depletion or exhaustion

2. Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job

3. Reduced professional efficacy.”

We may see this in colleagues as, for example, a reduction in engagement, irritability and frustration with self or others, a new lack of empathy or increasingly cynical behavior. In the early stages, individuals may work excessive hours. We should also be alert for recurrent physical symptoms e.g., headaches, abdominal pains, weight loss or poor sleep.

There are other predisposing factors to consider, such as family stress (young children, elderly dependents, sickness), financial distress, social isolation, long hours, poor working conditions (hard to assess in home workers but important to consider) and long hours.

According to the HSE, in the UK in 2020/21:

• There were an estimated 822,000 workers affected by work-related stress, depression, or anxiety. This represents 2.48% of workers (25 in every thousand)
• Work-related stress, depression or anxiety accounted for 50% of all work-related ill health.

This, of course, doesn’t necessarily include those whose physical health has deteriorated because of work-related stress. A MetLife UK survey is consistent with this, estimating the annual cost of burnout to UK businesses as greater than £700m.

• More than two in five (44%) respondents acknowledged to calling in sick with feelings of exhaustion, stress, depression, or feeling overwhelmed and unmotivated
• 54% of women reported struggling with burn-out, compared to 35% of men.

Interestingly, the headline to this article “10 million Brits pull sickie” highlights another issue: the lack of seriousness with which these symptoms may be treated. Worse, how can we expect an individual with symptoms of burnout to report these if they will potentially be seen as malingering?

What to do?

The first priority is recognition. It’s not until we realise what is going on that we can act. It can be very difficult to notice burn-out in oneself (think of the boiling frog analogy, with small slow increases in temperature being hard to spot).

Once identified, the priority is to reduce the predisposing conditions: avoid overtime, reduce meeting burden, limit tasks to realistic levels etc. A focus on team dynamics and enjoyment at work may also help. Outside of work, the focus should be on well-being: plenty of rest, time for enjoyable activities, connection to friends and family and regular exercise.

These changes sound deceptively simple; they can be very hard to implement, doubly so when burnt out. Support from a mental health professional can be incredibly helpful, perhaps focusing on symptoms of anxiety or depression, or maybe teaching the skills of mindfulness.

“As a GP myself, I’m very used to supporting patients in the early stages of burn-out and I am very grateful for the support of mental health colleagues in more complex cases. At Teladoc Health, we are proud to offer rapid and skilled advice to our patients, to help them reset and get back to fulfilling lives both at work and home.”

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