Arnold B. Baker and Patricia L. Costa. Chronic Job Burnout and Daily Functioning: A Theoretical Analysis:
"Burnout is a syndrome characterized by chronic exhaustion, cynicism, and a lack of personal accomplishment. It is usually defined as “…a state of exhaustion in which one is cynical about the value of one's occupation and doubtful of one's capacity to perform” (Maslach, Jackson, & Leiter, 1996, p. 20). Emotional exhaustion is the central strain dimension of burnout, described as feelings of being emotionally drained by one's work. Cynicism is a negative or excessively detached response to the work itself and/or to the individuals with whom employees’ interact while performing their job. Finally, lack of personal accomplishment refers to a decline in one's feelings of competence and of successful achievement at work (Maslach et al., 2001, Schaufeli et al., 2009b). Burned-out individuals simultaneously experience high levels of chronic fatigue, and distance themselves emotionally and cognitively from their work activities."
Ellen Frankel, The Five Books of Miriam, pp. 160-1 (Elisheva, wife of Aaron and mother of Nadab and Abihu, is speaking):
"All of the people shall observe a period of mourning," he announced, "and all the house of Israel shall bewail the burning that YHVH has wrought. But Aaron, together with Elazar and Itamar, Aaron's two remaining sons"- were they not my sons as well, my only two sons now that Nadab and Abihu were no more! - "these three shall not bare their heads nor rend their clothes, lest they die and anger strike the whole community. They shall remain within the Tent of Meeting." And then, without another word, he retreated back into the tent.
What was I to do now? Was I allowed to mourn? And who would comfort me, with my husband and two sons separated from me in the Tabernacle? But whether God wanted me to or not, I chose to mourn. If I was to be forbidden entrance to the holy altar, forbidden to accompany my dead sons outside the camp, forbidden even to seek comfort with my husband and two remaining sons, then I would not refuse the comfort of my community.
Simon G. Talbot and Wendy Dean, STAT News, July 26, 2018. Physicians aren't 'burning out.' They're suffering from moral injury.
The term “moral injury” was first used to describe soldiers’ responses to their actions in war. It represents “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.” Journalist Diane Silver describes it as “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.”
The moral injury of health care is not the offense of killing another human in the context of war. It is being unable to provide high-quality care and healing in the context of health care.
Most physicians enter medicine following a calling rather than a career path. They go into the field with a desire to help people. Many approach it with almost religious zeal, enduring lost sleep, lost years of young adulthood, huge opportunity costs, family strain, financial instability, disregard for personal health, and a multitude of other challenges. Each hurdle offers a lesson in endurance in the service of one’s goal which, starting in the third year of medical school, is sharply focused on ensuring the best care for one’s patients. Failing to consistently meet patients’ needs has a profound impact on physician wellbeing — this is the crux of consequent moral injury.
....
Navigating an ethical path among such intensely competing drivers (patient satisfaction surveys, profit margins, electronic documentation) is emotionally and morally exhausting. Continually being caught between the Hippocratic oath, a decade of training, and the realities of making a profit from people at their sickest and most vulnerable is an untenable and unreasonable demand. Routinely experiencing the suffering, anguish, and loss of being unable to deliver the care that patients need is deeply painful. These routine, incessant betrayals of patient care and trust are examples of “death by a thousand cuts.” Any one of them, delivered alone, might heal. But repeated on a daily basis, they coalesce into the moral injury of health care.