Why doctors and nurses hate the word 'burnout'

If there’s one word that’s been thrown around a lot over the past two years, it’s burnout.

And clinicians hate it.

“The word burnout is a bit triggering for me,” Pooja Aysola MD, MBA an emergency medicine physician, told me. “It makes it feel like it’s my fault.”

Aysola was on the frontlines of treating covid patients during the height of the pandemic – including those who refused to believe they had the virus. I interviewed her earlier this year for a special report on career transitions in healthcare, which LinkedIn data found were occurring at a much faster rate than prior to the pandemic. One common reason clinicians cited for leaving their jobs was burnout. But that’s not what they wanted to call it.

Burnout is a term that’s used across a range of industries to describe the mental, emotional or physical exhaustion that comes from work-overload. But clinicians who were on the frontlines of the pandemic say “exhaustion” doesn’t begin to cover what they’re feeling.???

Omolara Thomas, MD, MPH , a physician who now focuses on health equity initiatives, prefers the term “complex trauma” to describe what healthcare professionals faced over the past two years.

“That is a lot more difficult to treat,” she said. “Burnout is not burnout. It’s the threshold where you decide not to tolerate inhumane work conditions.”

During the height of the pandemic, working in a covid ward was often compared to being in a war zone. The death toll was mounting, and there was little healthcare professionals could do to stop it. Dying patients languished in hallways waiting for beds to open up. PPE was in short supply. And their own safety – and the safety of their families, by extension – was at risk.?

But the word “burnout,” clinicians say, places the burden squarely on them. It implies that they couldn’t handle the pressure, without giving any acknowledgment to the brutal working conditions they faced.

“When people come back from the military, we don’t say they’re burnt out,” said Kelsey Fassold , one of the former intensive care unit nurses I interviewed who made a pandemic-related career shift.?

At several points, Fassold emphasized that she has never quit anything in her life. But the symptoms of post-traumatic stress disorder, including nightmares and panic attacks, kept building. Her mental health was suffering – until one day, she was done.????

“Most of us have been diagnosed with PTSD,” she said. “I would start my shift at 4:30 and by 5, the anxiety and panic were coming in. And then it started to turn into dread.”

A number of studies around the globe have found high levels of mental health disorders – including anxiety, depression, insomnia and PTSD – among healthcare workers who were on the frontlines during the pandemic.?

Yet using the term “burnout” — a term thrown around many offices colloquially – can sanitize structural forces like staffing shortages and unsafe working conditions, including a rising number of violent incidents against healthcare workers.

A better term would be “structural violence,” said Russell Holman MD, MHM , a physician and former health system executive, “which means that the violence or the harm that comes to people is actually emanating from the environment in which they work.”

Thinking of that trauma as “burnout” also means that hospitals are focusing on the wrong tactics when it comes to addressing the underlying issues – something they need to do to stem the tide of healthcare workers who are leaving the profession.

“The interventions that are being done regarding burnout are all about individual wellness,” said Holman, CEO and founder of 1821 Health, which provides leadership training to clinicians. “But if every day, when you walk through the door to work, you're immersed in a harmful environment, then all of these things are going to have relatively little impact.”

To be sure, there are a host of reasons beyond covid that contribute to burnout, and a large number of healthcare professionals were battling burnout even before the pandemic. But covid added an accelerant to what was already a simmering crisis.

“The analogy that I would use is working in a nuclear power plant,” Holman said. “If there is a radiation leak from the reactor, we can tell people to just throw on a couple of extra suits. Or we can actually go try and fix the leak. I’m far more interested in helping fix the broken systems and culture from the inside out.”

What do you think of the word "burnout?" How would you describe what you're feeling these days?

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