Dec. 7, 2021 -- Efforts to combat burnout in health care professionals can be expanded to include patients with chronic conditions -- who can display some of the same telltale signs, such as prolonged stress, hopelessness, or feeling a loss of control.

Identifying these patients and acknowledging their increased burnout risk could improve the doctor-patient relationship as well as make patients more likely to follow treatment guidelines and boost outcomes, according to Adrienne Martinez-Hollingsworth, PhD, and colleagues.

The investigators created the “Burnout Dyad Model.” This strategy considers both sides of the health care professional-patient relationship, independently and together. It also moves burnout beyond the workplace.

"The unique part about the model is that traditionally, burnout has only been described as an employment-based illness; it has to be connected to your occupation," says Martinez-Hollingsworth, a professor and associate dean of the College of Nursing at Samuel Merritt University in Oakland, CA.

"But if you look at what patients of chronic illness go through, there's a lot of overlapping features, [including] the idea that there's some kind of long-term exhaustion,” she says.

The study was published this month in a special issue of the Journal of Continuing Education in the Health Professions.

Other burnout experts applaud the inclusion of patients.

"Dr. Martinez-Hollingsworth and colleagues are breaking important new ground in developing the concept of the ‘Burnout Dyad Model,’ which reframes the burnout conversation to recognize the pervasiveness of patient burnout and how it may affect clinical relationship, the quality of care, and numerous patient-centered outcomes," says Michael J. Brenner, MD.

Screening Could Help

"It is an interesting idea to consider asking patients with chronic conditions whether they have feelings of burnout in managing their disease," says Mark Thomas Hughes, MD, an assistant professor of medicine at Johns Hopkins Medicine in Baltimore.

"If the antidote to burnout is greater attention to resilience and well-being, and chronic disease directly impacts one’s sense of well-being, then it stands to reason that screening patients for burnout is a means of helping them cope with their chronic disease," he says.

Brenner agrees.

"There is no question that chronic conditions take a toll on patients, health professionals, and caregivers," says Brenner, an associate professor at the University of Michigan Medical School in Ann Arbor.

Understanding the frequency and scope of burnout in people with chronic conditions could help improve management and outcomes in this population, says Brenner, who published guidance online on Nov. 22 on how leaders can prevent burnout and instil resilience among health care professionals.

Patient-Centered Research

Burnout among health care professionals is well-studied and pervasive. For example, 42% of doctors reported they are burned out in “Death by 1000 Cuts”: Medscape National Physician Burnout & Suicide Report 2021.

Less is known about how often it shows up and how severe it is among patients.

To learn more, the investigators asked a diverse group of 25 health care professionals, patients, and caregivers about patient burnout during a Medicine X Conference at Stanford University. Interestingly, the group included providers who self-identified as chronic patients.

Hughes supports this approach.

"This is a thought-provoking study informed by a collaborative workshop experience between providers and patients … [that] adds an interesting dimension to our understanding of chronic disease management in a patient-centered way."

The strategy can also help patients become more involved.

"Seeing the patient as a team member in their own care opens up the dimension of burnout in their role as a caregiver for themselves," says Hughes, whose most recent publication on burnout is a Nov. 16 report on how the COVID-19 pandemic has contributed to health professional burnout.

Diabetes Is a Prime Example

The idea for the Burnout Dyad Model came from Martinez-Hollingsworth trying to understand a disconnect in patient-provider communication during diabetes treatment.

People with diabetes are at risk for burnout, especially when it comes to lifestyle or treatment guidelines.

"It's an everyday thing that affects every single decision you make throughout the day: How much exercise you get, how much sleep you get, whether you're eating, and how much you're eating," she says.

"To pretend that is any less fatiguing than treating diabetes, which is also exhausting for providers, to me seems like a very simplified view."

Social Explanations of Burnout

When evaluating burnout, using social factors that determine patient health also is important, Martinez-Hollingsworth says. People from traditionally displaced communities can be at higher burnout risk because they can lack resources that help other patients afford medications to manage their chronic health conditions.

"Hopefully, that shared understanding and open communication space will improve trust, which is one of the biggest challenges," she says.

Some health care professionals traditionally saw non-compliance as a moral failing, Martinez-Hollingsworth says.

"But we're not recognizing all the many steps that led up to them being in that position. It's essential to recognize some patients present with a history of lost trust opportunities … or disparities that the person has shouldered through their entire life course."

"But all we're seeing is that they show up late to every appointment," Martinez-Hollingsworth says.

One potential solution is to enlist more health care professionals from the same communities.

"If you get a patient from this background that you have to manage but you're also a provider from this background," it can improve the understanding of patient disease management and burnout challenges.