Correspondence (letter to the editor): Need to Differentiate Between Doctors' and Patients' Perspectives

The authors cite the review of a health technology assessment (HTA) commissioned by the German Institute for Medical Documentation and Information (DIMDI, Deutsches Institut für Medizinische Dokumentation und Information) on burnout (Cologne, 2010), which primarily complains about the lack of standardized diagnostic criteria. A fundamentally different perspective thus remains overlooked, according to which Herbert Freudenberger (1974) and burnout patients define burnout as a paradigm describing an impaired ability to perform and general malaise, providing an explanation (excessive professional/general stress), and providing an excuse (overwork). Freudenberger pointed out that the symptoms differed in each patient, which puts the phenomenon beyond any descriptive-operationalizeable ICD-10 entities. Experiencing burnout reflects primarily a subjective disturbance model in those affected. The perspective is diametrically opposed to that held by experts. If only standard recognized criteria existed: which individual who feels affected could be persuaded that they were not burnt out? Without a categorical differentiation between doctors'/therapists' perspectives and the patient's perspective, all attempts to define standard diagnostic criteria for burnout and valid instruments to measure burnout will predictably fail or remain frustrated. Burnout is substantially more than a fashionable diagnosis. The phenomenon presents an existential challenge for today's medicine, which is fixated on scientific criteria (among others, reliability, validity). On the one hand, there is a risk that doctors with a “customer friendly” focus uncritically jump on the “burnout wagon,” which may increase turnover in the short term but would result in a loss of long-established diagnostic and therapeutic standards. On the other hand, it is impossible to ignore the extent to which current psychiatric diagnoses according to ICD-10 have become removed from the needs of patients, who (rightly) desire not only a label for syndromes but an explanation for the suffering they are experiencing. The challenge is to find a balance between medical necessities and patients' needs that is fit for purpose in our time.