CITATION: Editorial| volume 394, issue 10209, p1591, November 02, 2019
Physician burnout: the need to rehumanize health systems
The Lancet
Published: November 02, 2019

Medical training and clinical practice are continuously associated with stress—often welcomed and considered a positive motivating factor. However, the recently recognised triad of emotional exhaustion, depersonalisation, and reduced professional efficacy, defined as burnout, questions the role of stress in clinical practice. Burnout has the propensity to put patient care at risk and has a detrimental effect on medical workforce retainment. A health-care system under pressure undoubtably contributes to professional burnout: long working hours, outdated and not fit-for-purpose technologies, and mounting documentation requirements shift the focus away from patient care, causing work–life imbalance, insufficient job resources, ineffective multidisciplinary teams, and a dismissive organisational culture. Physician burnout is now recognised as a global health-care predicament. In the US, burnout affects more than half of practising physicians and, more worryingly, is on the rise among medical students and trainees…

In response to concerning rates of burnout among US clinicians and trainees, the National Academy of Medicine published a report, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-being, on Oct 23. The report aims to find solutions to burnout by shifting focus away from the individual and by proposing systemic changes in health-care organisations, academic institutions, and at all levels of government… The report, albeit tailored for a US audience, has global implications… Patient-centred health systems that reinstate physicians’ sense of purpose and promote a higher degree of physician interconnectedness have the potential to rehumanise health care.

Comment (NPW): It would be interesting to hear more about the differences in challenges and burn-out across different settings. Many clinicians in low- and middle-income countries are working in situations that are disempowering, with potentially devastating consequences for them and their patients. The editorial focuses on burnout in physicians, but this is an issue that cuts across all cadres. On HIFA we are currently looking at CHWs, who might be at increased risk of burnout associated with an ever-increasing workload, unrealistic expectations, and harmful supervision practices.

Best wishes, Neil

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