J Eval Clin Pract. 2018 Oct;24(5):1150-1157. doi: 10.1111/jep.12986. Epub 2018 Jul 12.
Suffering without a medical diagnosis. A critical view on the biomedical attitudes towards persons suffering from burnout and the implications for medical care.
Journal of evaluation in clinical practice
Karin Mohn Engebretsen
Affiliations
Affiliations
- Medical Faculty, Institute of Health and Society, University of Oslo, Oslo, Norway.
PMID: 30003618
DOI: 10.1111/jep.12986
Abstract
The search for causal explanations in medically unexplained syndromes such as burnout has not been resolved by evidence-based medicine. A biomedical model encourages a reductionist diagnostic practice and a dualist split between physical and psychological symptoms. Therefore, diagnosing and treating these syndromes remains a challenge. Depression is a common aspect in burnout and, as a result, clinicians often diagnose burnout patients as depressed. The Norwegian government expects medical efficiency to reduce sick leaves. Medically treating depression has a documented effect. This practice may pose threats to the increasing number of individuals experiencing burnout. The clinical guidelines in evidence-based medicine mirror what counts as knowledge in medical inquiry, which in turn shapes attitudes towards individual patients. The aim of this article is 2-fold: firstly, to assess how the values that accompany the biomedical paradigm affect clinical care, and secondly, to replace the biomedical model with a genuine person-centred approach. In the study described, an existential phenomenological method was applied. Eight individuals, who experienced burnout, were included. They had been on long-term sick leave (>1 year) due to symptoms of fatigue and pain and fulfilled the criteria for Exhaustion Disorder (ICD-10, F43.8A). Their symptoms were not medically explained, and almost all the participants were labelled as depressed. Four themes emerged that described how they experienced living with burnout: "unhomelike being in the world," "the limit of diagnosis," "naked in the eyes of the public," and "a path to hopelessness." I identify 2 main problems; firstly, the mismatch between the patient's experience of his or her illness and the doctor's interpretation of the condition can lead to ineffective treatment. Secondly, the interviewees struggled to be recognized as ill. Thus, the inherent values in the biomedical paradigm might have serious implications for the medical care of patients with burnout.
© 2018 John Wiley & Sons, Ltd.
Keywords: diagnosis; evidence-based medicine; guidelines; multi-morbidity; person-centred health care
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