Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Call a consult: depression vs. burnout

Kara Pepper, MD
Physician
September 8, 2020
Share
Tweet
Share

CC: “I feel like crap.”

HPI: 29-year old female internal medicine resident. Hasn’t seen sunlight in over three months due to 100 hour work weeks.  Crying at work. Always exhausted and irritable.  Isolated from friends and family.  Feels guilty that she is not effective at work and home.  States recent labs were normal.

ROS:

Gen: hypersomnia
HEENT: teeth grinding
CV: chest pressure, palpitations
GI: decreased appetite with weight loss
Neuro: headaches
Psych: apathetic, not suicidal

Meds: none

Social: alcohol on golden weekends

Exam: normal

What is your diagnosis?

  1. Depression
  2. Burnout
  3. Both
  4. Neither

What is your treatment?

  1. Prescribe SSRI.
  2. Prescribe a vacation from work.
  3. Tell her this is normal for residents, and that life will be better after graduation.
  4. Other

During the nadir of my internal medicine residency, I worked for several months in a row of 100 hour work weeks.  I did not see the winter sun for months.  As a peer leader in our program, my colleagues came to me with familiar complaints of loneliness, overwhelm, exhaustion, and grief.   As there was no time to seek medical evaluation, how was I to feel better?  Adept at managing septic shock in the ICU, I assumed I could care for my own health.  I started myself on an SSRI for depression and had some improvement in my symptoms.  I was no longer irritable, but I was still exhausted and unhappy.

My intervention did not address my real issues –  a complex blend of burnout and depression in a culture of medicine that did not promote wellness and my own inability to ask for help.

Depression and burnout have common symptoms, but depression is a medical diagnosis, and burnout is an occupational hazard.  It is so important to distinguish between the two.  You would not hire a scribe to treat your depression, nor would you take an SSRI to solve your work-induced burnout.

Rates of depression among interns entering residency are approximately 4% at the start of training and increase to about 25% within three months.  As burnout scores increase, the risk for depression also increases.  More than 80% of physicians with high burnout scores meet the criteria for provisional diagnoses of depression.  According to the 2020 Medscape National Physician Burnout & Suicide Report, approximately 22% of physicians reported thoughts of suicide, and 39% had told no one.

As an executive coach for physicians who are struggling with burnout, I often joke that my clients’ chief complaint is, “I feel like crap.” After our initial conversation, I refer approximately 10% of my potential clients to mental health providers – psychiatrists, primary care physicians, and therapists – to address their depression or trauma.  It is much easier and socially acceptable for physicians to admit to burnout rather than depression.  This misdiagnosis (mislabeling of symptoms) can lead to a delay in diagnosis and treatment of depression, a potentially life-threatening illness.  Certainly stigma, lack of access and time for mental health providers, and mandatory reporting of mental health diagnoses to state licensing boards compounds this problem.

We know that physicians are most likely to rely on their colleagues for support when they are in crisis.  We are uniquely qualified to understand and empathize with our suffering colleagues.  If you see that a colleague is suffering, please reach out to them.  If a colleague asks you for help, they need it.

I have been depressed.

I have been burned out.

I have been both.

I have been neither.

How do you know if you are depressed vs. burned out when your chief complaint is, “I feel like crap?” It’s time to call a consult.  I don’t mean curbsiding your colleagues to fill your medications off the record without evaluation. I mean, ask for real help, from someone who can objectively help you define your diagnosis and the best path forward.  If you “feel like crap” and think you may be depressed or burned out, please reach out to a trusted physician, therapist, or coach.  You are not alone, and there is hope and help waiting for you.

Kara Pepper is an internal medicine physician and can be reached at her self-titled site, Physician Life Coach: Kara Pepper, MD.

ADVERTISEMENT

Image credit: Shutterstock.com

Prev

Are the life sciences the best premedical majors?

September 8, 2020 Kevin 1
…
Next

The most common misconception about spine surgery

September 8, 2020 Kevin 0
…

Tagged as: Psychiatry

Post navigation

< Previous Post
Are the life sciences the best premedical majors?
Next Post >
The most common misconception about spine surgery

ADVERTISEMENT

More by Kara Pepper, MD

  • Marketing as a clinician isn’t about selling. It’s about trust.

    Kara Pepper, MD
  • From burnout to balance: 5 stages of career transformation

    Kara Pepper, MD
  • The story of a physician, after a year sober

    Kara Pepper, MD

Related Posts

  • Treating depression with ketamine: We need incremental treatment for depression

    Shaili Jain, MD
  • Physicians are at the frontline of depression

    Michele Luckenbaugh
  • A physician’s addiction to social media

    Amanda Xi, MD
  • Surviving medical school with depression

    Anonymous
  • My depression won’t defeat me

    Ronna Edelstein
  • Physician Suicide Awareness Day: Where are the patients? 

    Jennifer M. Sweeney

More in Physician

  • The gift we keep giving: How medicine demands everything—even our holidays

    Tomi Mitchell, MD
  • From burnout to balance: a neurosurgeon’s bold career redesign

    Jessie Mahoney, MD
  • Why working in Hawai’i health care isn’t all paradise

    Clayton Foster, MD
  • How New Mexico became a malpractice lawsuit hotspot

    Patrick Hudson, MD
  • Why compassion—not credentials—defines great doctors

    Dr. Saad S. Alshohaib
  • Why Canada is losing its skilled immigrant doctors

    Olumuyiwa Bamgbade, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • From Founding Fathers to modern battles: physician activism in a politicized era [PODCAST]

      The Podcast by KevinMD | Podcast
    • From stigma to science: Rethinking the U.S. drug scheduling system

      Artin Asadipooya | Meds
    • The gift we keep giving: How medicine demands everything—even our holidays

      Tomi Mitchell, MD | Physician
    • The promise and perils of AI in health care: Why we need better testing standards

      Max Rollwage, PhD | Tech
    • From burnout to balance: a neurosurgeon’s bold career redesign

      Jessie Mahoney, MD | Physician
    • Healing the doctor-patient relationship by attacking administrative inefficiencies

      Allen Fredrickson | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • From Founding Fathers to modern battles: physician activism in a politicized era [PODCAST]

      The Podcast by KevinMD | Podcast
    • From stigma to science: Rethinking the U.S. drug scheduling system

      Artin Asadipooya | Meds
    • The gift we keep giving: How medicine demands everything—even our holidays

      Tomi Mitchell, MD | Physician
    • The promise and perils of AI in health care: Why we need better testing standards

      Max Rollwage, PhD | Tech
    • From burnout to balance: a neurosurgeon’s bold career redesign

      Jessie Mahoney, MD | Physician
    • Healing the doctor-patient relationship by attacking administrative inefficiencies

      Allen Fredrickson | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...