Burnout is usually identified by three major symptoms: emotional exhaustion, depersonalisation, and decreased sense of self-efficacy. But burnout, we believe, is also a euphemism for what many physicians experience as a crisis of meaning and identity. A deeper understanding of burnout, we suggest, begins by acknowledging its context: physicians in many developed countries live and work in a technocentric, dehumanised, and financially driven environment, often within a broken and unjust system of health care. Those who work in academic health centres face institutional strains caused by the marketplace restructuring of health care, a shrinking safety net, more indigent patients to care for, and increasing competition for research funding. Their counterparts in developing countries often work under conditions that are shaped by inadequate resources, a shortage of health workers, and weak health-care systems. In different settings worldwide, therefore, physicians may work under conditions that increasingly prevent them from living up to their highest ideals. This is the background for grasping the valuable definition of Christina Maslach and Michael Leiter: “Burnout is the index of dislocation between what people are and what they have to do. It represents an erosion in values, dignity, spirit, and will—and erosion of the human soul.”
“This is the time when people hate you as a doctor. You have failed, flunked, dropped the ball. You should be sued—you will be sued. You are a quack…And a part of you believes all this because no matter how sure thing the death was, some part of you believes you really can perform miracles.”