That half of doctors in the USA may have symptoms of burnout (work-related emotional exhaustion, depersonalisation, and a sense of diminished accomplishment) is shocking. Even more shocking is the disproportionately small amount of attention that burnout receives from the profession, health systems, and patients. One reason for the relative silence surrounding burnout and its adverse effects on physicians and patients might be the lack of consensus about aetiology. This is shown by an exchange of letters in today's Lancet, between Renzo Bianchi, Irvin Schonfeld, and Eric Laurent, who frame burnout within a mental health paradigm, and Ronald Epstein and Michael Privitera who advance a systems approach.
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