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WHO adds burnout to ICD-11
Burnout has been added to the 11th revision of the International Classification of Diseases, according to a news release.
According to WHO, burnout results from chronic workplace stress that has not been managed successfully. In the ICD-11 entry, burnout was filed under problems tied to employment or unemployment.
Burnout 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 one's job; and
- reduced professional efficacy.
However, the diagnosis should exclude adjustment disorder, disorders specifically linked to stress and anxiety- or fear-related disorder.
Healio Psychiatry previously reported on a paper in which experts from leading U.S. health organizations deemed physician burnout “a public health crisis.”
“Physician burnout has received some attention in recent years, but not enough. As a result, it is both poorly understood and getting worse,” Andrew R. Iliff, MA, JD, lead writer and program manager at Harvard Global Health Institute, told Healio Psychiatry.
In their paper, experts from Harvard T.H. Chan School of Public Health, the Harvard Global Health Institute, the Massachusetts Medical Society and the Massachusetts Health and Hospital Association recommended ways to address the prevalence of burnout among physicians and other health care providers. Recommendations included:
- appointing an executive-level chief wellness officer (CWO) at every major health care organization;
- providing support for those experiencing burnout; and
- improving the efficiency of electronic health records.
“Our ongoing failure to address increasing physician burnout threatens to undermine the provision of care,” Iliff said. “But we have a pretty good idea how to fix it — starting with making physician wellness a top priority at health care organizations and streamlining electronic health records to allow physicians to focus on patient care.” – by Savannah Demko
References:
Jha AK, et al. A crisis in health care: A call to action on physician burnout. https://cdn1.sph.harvard.edu/wp-content/uploads/sites/21/2019/01/PhysicianBurnoutReport2018FINAL.pdf. Accessed on May 28, 2019.
WHO. ICD-11 for mortality and morbidity statistics. QD85 burn-out. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/129180281. Accessed on May 28, 2019.
Disclosure: Healio Psychiatry was unable to confirm relevant financial disclosures at the time of publication.
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The 11th revision of the International Classification of Diseases now recognizes burnout as an occupational phenomenon. Importantly, they distinguish this occupational phenomenon from a medical condition. This is critical as it takes the burden off the individual experiencing the symptoms and looks more broadly at the interaction between the person and the environment.
There are significant clinical implications with this classification as well: 1) It provides individuals with an opportunity to seek help without the stigma many fear around mental illness in the workplace. 2) It guides interventions to focus on change in the environment as well as the individual’s relationship to their environment. Many people who experience burnout think "there must be something wrong with me." I hope this new classification diminishes the internalization of this experience.
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I wasn’t a part of this decision, but it’s important to make the distinction that the WHO is not saying that burnout is a medical diagnosis, it’s just changing the classification so that burnout is an occupational hazard.
This is an important distinction because classifying burnout as a medical condition has the potential to do harm — or at least not be productive — for a few different reasons. First, I think burnout is still poorly defined. We tried to conduct a meta-analysis of burnout among physicians, but it was impossible to come to major conclusions because out of 181 studies, there were 140 different definitions of burnout. With everyone defining it their own way, the term loses meaning in research. Colloquially, different doctors use it to mean very different phenomena.
Another problem is that burnout is classified and conceptualized as a purely workplace-related disorder — that it can be attributed completely to the workplace. But the research to doesn’t seem to indicate that this assertion is true. Instead, burnout looks similar to depression and other psychiatric disorders in that it’s multifactorial and complex. You’re more likely to have symptoms of emotional exhaustion and depersonalization if you’re stressed out at home and having difficulties with your marriage or with kids, or having to care for an older parent or you have a 3-hour commute. Many of the factors that contribute to depression also contribute to burnout.
In general, I’ve been in favor of focusing a little bit more on the established mental disorders, particularly depression, because we know more about what causes it and perhaps most importantly, we have interventions and treatments for it. Because burnout is usually classified and thought of as a workplace disorder, we haven’t developed ways to help individual clinicians who are burned out aside from making overall improvements to the workplace and system. Whereas with depression, we know of treatments like psychotherapy, and even medication when it’s needed, that help. We know what depression is and it’s generally defined the same way across studies and clinicians. Using those established psychiatric disorders makes sense, and I think moving burnout toward a clinical diagnosis could do harm because it could take away from that.