INTERVIEW – The HAS has issued recommendations to deal with burn-out. According to psychiatrist Patrick Légeron, they remain insufficient.
Burnout, this catch-all concept, is the subject of new recommendations from the Haute Autorité de Santé. The body wanted to guide occupational physicians and general practitioners, faced with a very common syndrome and despite everything, particularly difficult to diagnose as its symptoms, varied and transverse, can be similar to those of other diseases.
While the lawmakers of the previous mandate planked on a project of recognition as an occupational disease, France is more committed in this complex field of occupational medicine. However, according to the psychiatrist Patrick Légeron, founder of the consultancy firm “Stimulus” and co-author of the report of the Academy of Medicine (2016) on burnout, the latest recommendations do not really make it possible to take the hurt. root.
Did doctors really need HAS to position itself?
Dr Patrick Légeron: Yes, first of all because it is a problem that we talk about a lot and whose reality, even if it is poorly understood, is quite worrying. In addition, it turns out that the medical profession is very poorly trained. It is true of occupational physicians: even if they are being trained more and more and are now fairly well informed, we can improve their expertise in this area. But this is especially true of general practitioners, who are a little lost. Moreover, when we do surveys, it is astonishing to note that general practitioners explain that a very large part of the problems that they are brought to see with their patients are of a psychological nature.
This is indeed a new pathology. We talk a lot about diseases of the 21st century, that is right and stress is part of it, just as there were new infectious diseases in the Middle Ages. This HAS guide was needed, which shows that the issue is taken into account by health authorities and not just by the Ministry of Labor alone, as has been the case for a long time. The report of the Academy of Medicine had also concluded on the need to train health professionals, from their medical studies.
Do these recommendations meet the needs?
Dr Patrick Légeron: En part, only. The criticism I can make is that we remain in a very French culture, where prevention occupies a very weak place. This report shows how much emphasis is placed on taking charge of and returning to work, which are fundamental areas. But prevention is unfortunately put aside.
I am afraid that we will reiterate the mistake made with corporate suicide ten years ago. At the time, the debate had mainly focused on recognition, responsibility, accountability, but so little on prevention. Today, there are still as many suicides in the workplace as there were ten years ago, and companies are no further ahead in preventing workplace suicide. I’m afraid this is the case again in this report. That said, it is aimed at doctors. However, prevention is a matter of work organization, management… This undoubtedly takes place at the level of companies, but despite all the doctors have a role to play in prevention.
The entire interview with Patrick Légeron, psychiatrist
Despite everything, do these recommendations allow doctors to refine their diagnosis?
Dr Patrick Légeron: Certainly, but there remains a major difficulty. In my opinion, we cannot very clearly distinguish the purely pathological aspects and the subclinical aspects, that is to say what is undoubtedly suffering, but which cannot be considered as a pathology. “Simple” exhaustion, “simple” fatigue, cannot be compared to burnout in the pathological sense. It’s a bit like distinguishing between sadness and depression in the psychiatric sense of the term. I think we could have gone a little further in the recommendations to help general practitioners make a difference.
There are still a few scales, a few benchmarks to assess these symptoms. I think that France has a major difficulty compared to English-speaking countries, which is that we have translated the word “burn-out” a bit quickly as exhaustion. However, that is not the translation. In the word “burn-out”, there is the notion of burn-out. One of the important dimensions of burn-out, beyond exhaustion, is “burning”, the internal burning of emotions.
In fact, burnout corresponds to a symptomatological tripod: exhaustion, of course, accompanied by a destruction of emotions (dehumanization), and a feeling of non-fulfillment (loss of self-esteem).
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