Disenfranchised Grief and Physician Burnout

I was pleased to read Dr. Lathrop's reflection on Disenfranchised Grief and Physician Burnout in the July/August issue of Annals of Family Medicine. I had the opportunity to learn about this concept from the author last year, and it has changed the way that I think about my work with students, residents, and faculty physicians. The magnitude of change that family physicians have faced in the last 15 years cannot be understated, with the increase in intrusions into daily practice that compete with the doctor-patient relationship and the explosion of non-value-added tasks that consume time and energy. This, coupled with the loss of autonomy that often accompanies the movement from independent practice to employment models, are well documented in their negative impact on the joy in practice and increasing rates of burnout.

What was so important to me about this article was the naming of the feelings that accompany these very personal reactions - grief. We are well-trained to recognize grief, understand its stages, and support patients and families through this process. That is not as true of "burnout," the recognition of which often escapes us until it is at an advanced or terminal stage. Considering burnout, or better yet, impeding burnout, through the lens of grief can help us increase our empathy with colleagues, bringing them in closer rather than watching helplessly as they struggle. It also begins to offer an explanation that does not appear to put the responsibility for the condition back on the physician, to "learn to become more resilient," as is often the focus of burnout conferences and programs.

It is clear that our systems of care need to change - for patients and for those who provide their care. Relationship-centeredness must re-emerge as a priority, and we must be at the table substantially influencing decisions about practice. If this happens - and we realize a more rationale and meaningful approach to our work - we can look back at this as a silver lining to our enhanced understanding of the drivers of burnout. In the meantime, we have the responsibility to prepare our learners and support our colleagues to navigate this transition. Choosing to view it through the lens of grief provides a validated framework with which we have greater comfort in using through our clinical training.

Competing interests: None declared