When an animal is shot and bleeds to death, does it “suffer from a bleed out”? No, the hunter shot and killed it – that’s the truth, and that’s the main narrative. “Bleeding out” was a natural consequence. Yet in health care, it feels as though the narrative has been cleverly turned on its head and reflected back to health care workers as “suffering from burnout,” giving the culprit workplace a pass.
With burnout being the chief narrative, the burden and focus on treating it is conveniently shifted to workers. Indeed, hospitals and clinics have introduced interventions to “fix the worker” with a focus on “training” on coping skills, improving mental health, team building, counseling, pizzas, mindfulness, empathy, etc. The real workplace culprits, such as excessive workload, high patient-to-staff ratios, disruptive patients and clinicians, the burden of documentation, ever-changing rules and laws, excessive regulations, professional stagnation, and superhuman expectations, are either swept under the rug or unfortunately ignored. Even a PubMed search on burnout prevention and treatment is chock-full of coping strategies for health care workers instead of actually changing the workplace.
Why isn’t there a catchy, mainstream, and meme-worthy term for the culprit workplace like burnout? A workplace-centric term is clearly missing. Maybe “toxic workplace environment” makes the cut? Toxic workplaces need to be the main narrative since burnout is only a consequence. It’s the symptom, not the disease. Treating a cough is not the main goal for pneumonia; treating the infection is. Likewise, treating burnout in health care shouldn’t be the main goal; detoxifying the workplace should be.
It irks me that burnout has its own ICD-11 code (QD85) and its own WHO definition. Interestingly, the WHO first called burnout a disease; a few hours later, they changed it from “disease” to “phenomenon.” I agree with this, but only because the toxic workplace environment is the actual disease, and it needs its own ICD code. Dr. Sinsky of the American Medical Association (AMA) says, “The best response to burnout is to focus on fixing the workplace rather than fixing the worker.” Maybe the Surgeon General’s advisory on burnout published in 2022 is a start?
Some argue there simply aren’t enough medical staff available to make a better workplace happen. That reminds me of the famous quote from the movie Field of Dreams: “If you build it, he will come.” Prioritize building a better health care workplace, and they will come … and stay.
Chetan Wasekar is a hospitalist.