A cross-sectional, postal survey of GPs has found worryingly high levels of burnout. The study revealed high scores for emotional exhaustion and depersonalisation in more than four out of ten respondents, and low scores for perceived personal achievement in a third.

All 789 NHS GPs currently practising in Essex were sent a Maslach Burnout Inventory (MBI) to complete. There was a high response rate: 564 doctors (71%) completed the questionnaire.

The MBI consists of 22 items, each scored from 0 to 6, which measure the three components of burnout:

• emotional exhaustion (9 items)

• depersonalisation (5 items)

• personal achievement (8 items)

The scores for each component are calculated separately and are not combined in a single total score.

Hence, there were three scores for each respondent, which were categorised as low, average or high using the cut-off points from the original validation study. That study involved a sample of 1,104 North American physicians and nurses divided into three groups of equal size (33% of subjects) for each of the three components.¹

Almost half the respondents (46%) had a high score for emotional exhaustion; 42% had a high score for depersonalisation and 34% had a low score for personal achievement.

Male GPs, doctors registered for < 20 years and those from larger practices had significantly higher depersonalisation scores than female GPs, those registered for ≥ 20 years and single-handed GPs.

A stratified sample of 38 GPs was assessed by patient post-consultation questionnaires and analysis of audio-taped consultations. No significant association was found between depersonalisation scores and patient-rated interpersonal skills or observed patient-centredness.

The authors define burnout as ‘a work-related syndrome with high scores on the MBI,’ but this is vague and potentially misleading. There is no agreed definition: one suggestion is that the diagnosis of burnout should be restricted to those with a high score in all three burnout domains,² but others have considered those with either a high level of emotional exhaustion or a high level of depersonalisation to be burnt out.³

A further source of confusion is the fact that no explicit comparison with the validation group was made. If the UK doctors had the same levels of burnout as their American colleagues, 33% of the sample would be expected to score highly for each of the three components.

The conclusion should be that UK GPs have higher levels of emotional exhaustion and depersonalisation, but not lower levels of perceived personal achievement, than a group of North American medical professionals surveyed in the mid-1980s.

Although it is not precisely defined, burnout is a useful concept which describes the emotional exhaustion, loss of compassion and sense of failure which result from chronic uncontrolled demands and an imbalance between the physical and emotional effort expended and the satisfaction gained from work.⁴

Those who are enthusiastic, dedicated and committed to their work are more likely to succumb: ‘you have to be on fire before you can burn out.’⁵

It is suprising that, in the current study, depersonalisation did not appear to be associated with impaired performance. The findings of previous studies are conflicting: in one study burnt out residents were significantly more likely to self-report suboptimal patient care3 but another found that burnout did not increase the risk of medical errors.⁶ However, burnout is significantly associated with depression,3 which does substantially increase the likelihood of medical errors.⁶

We all have a responsibility towards our colleagues, and can help protect one another from burnout by providing mutual support and positive feedback. I have found that 360° appraisal can facilitate this, and would recommend just two questions:

• Of the things which colleague X brings to the partnership, what do you particularly value?

• What difficulties do you think that he or she faces: how can we help him/her to overcome them?

Dr Phillip Bland