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Erosion of the ‘ethical’ doctor-patient relationship and the rise of physician burn-out
  1. Atara Messinger1,
  2. Sunit Das2
  1. 1Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  2. 2Division of Neurosurgery and Centre for Ethics, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Atara Messinger, Department of Psychiatry, University of Toronto, Toronto, ON M5T1R8, Canada; atara.messinger{at}mail.utoronto.ca

Abstract

This paper examines the topic of physician burn-out from a philosophical lens. We explore the question of how the rise of physician burn-out may be related to an underlying erosion of meaning in medicine, characterised by the breakdown of the intersubjective relationship between doctors and patients. We argue that while commonly cited strategies for addressing burnout—including promoting work-life integration, cultivating workplace community, and fostering resilience—are critical for enhancing physician well-being, the common thread linking these approaches is that each identifies the physician as the primary locus of intervention. We propose that physician-centric approaches alone may be insufficient in addressing burnout, as the work might also involve shifting our attention to the intersubjective space that exists between the physician and the patient. To further elucidate the connection between intersubjectivity and the creation of meaning in medicine, we call on twentieth-century philosopher Emmanuel Levinas. Applying Levinas’s philosophy to the clinical context, we discuss the phenomenon of ‘depersonalisation’ and ask whether, rather than a mere consequence of burnout, depersonalisation might be a core cause of this condition. With these points we shed light on an idea that is relatively absent from the burn-out literature: that a person-oriented approach is vital not only for patient well-being but for physician wellness as well, as a process that ‘de-personalizes’ patients might result in a simultaneous dehumanisation of physicians themselves. Drawing inspiration from Levinas, we explore how a reorientation towards the intersubjective, dialogical dimension of the doctor-patient dyad could serve as one important ingredient in healing not only the patient, but the physician as well.

  • Doctor
  • philosophy of medicine/health care

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Footnotes

  • Contributors AM wrote the original draft of the manuscript and is responsible for the overall content as guarantor. AM and SD both contributed to the conceptualisation and construction of the argument and were directly involved in the editing and revision process.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.