Correspondence (letter to the editor): Term Indicates Severity of Exhaustion

Whether the term burnout is fashionable or not, Germany’s population is increasingly exhausted, and this includes doctors themselves. It is obvious to me too that research is needed regarding the classification, diagnostic evaluation, and therapy, and to establish the scientific basis. However, I would like to continue using this diagnostic term on sick notes. I take a pragmatic view as this term reflects the severity of a patient’s exhaustion if, for example, someone is still exhausted to the same degree of severity after being signed of sick for four weeks, if sadness was not the primary factor, and if the preceding workload was enormous.

According to Farber (reference 7 in the review article by Kaschka et al.), it is a patient’s internal pressure to be better than others, have more money, etc. The authors mention six internal personality factors in this context.

Among the 22 external factors that vitally contribute to burnout, the authors mention the word “pressure” several times. I also see this pressure in people’s increased workloads, thanks to which Germany again became the engine of the European Union according to the Agenda 2010. Almost all work sectors are affected. The authors justifiably demand preventive measures in occupational health promotion.

In order to avert multifactorial burnout, health promotion should be started early; conflict training, for example, should be included in school curricula, while the ability to work as part of a team, relaxation techniques, regular breaks, part-time working, reduction in bureaucratic processes, and adequate pay are also vitally important.

For doctors, burnout could be prevented largely by changing the remuneration system, by giving doctors and patients back the necessary time by paying adequately for this. It is a fact that doctors are forced to take on more work because they are remunerated on the basis of case numbers in the outpatient system and diagnosis-related flat-rate payments in hospitals (with increasingly shorter intervals between admission and discharge).