Uma bateria de carro quebrada

por Brendon Nafziger, DOTmed News Associate Editor | September 17, 2012
From the September 2012 issue of HealthCare Business News magazine

A friend of mine doing residency rounds in the emergency room of a busy public hospital in Brooklyn took to calling himself the "Angel of Death." "All my patients die," he said.

Poor, largely Caribbean, the people he saw mostly lived on the fringes. Many were what the late Paul Fussell called the "bottom out of sights," and by the time they came to the emergency room - which was the only place most of them ever so much as spoke to a health care provider - there was often little that could be done for them.

Some were wasting away from the sort of tropical diseases no one would expect to exist in New York City. Most had long neglected chronic illnesses. One young pregnant woman who came in was so malnourished or drug-addled, her heart stopped shortly after she was put on a bed. (Doctors managed to revive her.)

My friend has since transferred to a private hospital in uptown Manhattan, but you could tell that the long hours he was forced to put in as a resident and the hopeless misery of his patients took their toll on him.

It should come as little surprise then that a study published in an August issue of the Annals of Internal Medicine found almost half of U.S. doctors suffer "burnout," with emergency medicine specialists the most afflicted.

Burnout is not exactly a medical term, and definitions vary. But psychologist Christina Maslach, who more or less helped inaugurate "burnout studies" some 30 years ago and developed the 22-question inventory still in use today, hit upon three main criteria: emotional exhaustion, indifference to the fate of people you're tasked with helping, and feeling burdened with the sense that nothing you do matters.

It's believed to be quite widespread. A 2000 article in Occupational Medicine, despite noting that as definitions are not uniform the "prevalence rates published in the literature of individual occupations must be regarded skeptically," said as many as one-third of teachers suffer from it, and even one out of 10 dentists.

But as I'm a writer, not a doctor, I find the word's rather murky history to be my main point of interest. I had thought the 1960 Graham Greene novel, a "Burnt- Out Case," which described the life of a London architect who gets fed up with everything and travels to Africa in search of meaning and adventure, to be the origin of the term. But it likely only entered wider circulation after it was used in a study in the early 1970s by the psychologist Herbert Freudenberger to describe staff at a volunteer clinic for drug addicts. Freudenberger poached the word, not from the British novelist, but from his patients. It was slang for a junkie.

Not only is it common in America, but the word has gone global, becoming the preferred term in languages that have native equivalents, according to Wilmar Schaufeli and Dirk Enzmann, in their 1998 textbook, "The Burnout Companion to Study & Practice: a Critical Analysis."

However, Schaufeli and Enzmann don't think the metaphor is that accurate, finding it "too static," and I'm inclined to agree.

"A broken car battery that cannot be recharged and loses its power bit by bit is a better comparison than the notion of a fixed amount of energy that is slowly consumed until nothing is left," they write. "Indeed, burned-out individuals often describe themselves spontaneously as empty batteries that can no longer be recharged."

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