Engebretsen Karin Mohn
Medical Faculty, Institute of Health and Society, University of Oslo, Oslo, Norway.
J Eval Clin Pract. 2018 Oct;24(5):1150-1157. doi: 10.1111/jep.12986. Epub 2018 Jul 12.
The search for causal explanations in medically unexplained syndromes such as burnout has not been resolved by evidence-based medicine. A biomedical model encourages a reductionist diagnostic practice and a dualist split between physical and psychological symptoms. Therefore, diagnosing and treating these syndromes remains a challenge. Depression is a common aspect in burnout and, as a result, clinicians often diagnose burnout patients as depressed. The Norwegian government expects medical efficiency to reduce sick leaves. Medically treating depression has a documented effect. This practice may pose threats to the increasing number of individuals experiencing burnout. The clinical guidelines in evidence-based medicine mirror what counts as knowledge in medical inquiry, which in turn shapes attitudes towards individual patients. The aim of this article is 2-fold: firstly, to assess how the values that accompany the biomedical paradigm affect clinical care, and secondly, to replace the biomedical model with a genuine person-centred approach. In the study described, an existential phenomenological method was applied. Eight individuals, who experienced burnout, were included. They had been on long-term sick leave (>1 year) due to symptoms of fatigue and pain and fulfilled the criteria for Exhaustion Disorder (ICD-10, F43.8A). Their symptoms were not medically explained, and almost all the participants were labelled as depressed. Four themes emerged that described how they experienced living with burnout: "unhomelike being in the world," "the limit of diagnosis," "naked in the eyes of the public," and "a path to hopelessness." I identify 2 main problems; firstly, the mismatch between the patient's experience of his or her illness and the doctor's interpretation of the condition can lead to ineffective treatment. Secondly, the interviewees struggled to be recognized as ill. Thus, the inherent values in the biomedical paradigm might have serious implications for the medical care of patients with burnout.
在诸如职业倦怠等医学上无法解释的综合征中寻找因果解释，这一问题尚未得到循证医学的解决。生物医学模式鼓励采用还原论的诊断方法，并将身体症状和心理症状二元分割开来。因此，诊断和治疗这些综合征仍然是一项挑战。抑郁症是职业倦怠的一个常见方面，因此，临床医生常常将职业倦怠患者诊断为患有抑郁症。挪威政府期望提高医疗效率以减少病假。医学上治疗抑郁症已有确切疗效。这种做法可能会对越来越多经历职业倦怠的人构成威胁。循证医学的临床指南反映了医学探究中被视为知识的内容，这反过来又塑造了对个体患者的态度。本文的目的有两个：第一，评估生物医学范式所附带的价值观如何影响临床护理；第二，用真正以患者为中心的方法取代生物医学模式。在所描述的研究中，采用了存在主义现象学方法。纳入了8名经历职业倦怠的个体。他们因疲劳和疼痛症状长期病假（超过1年），并符合精疲力竭障碍（ICD - 10，F43.8A）的标准。他们的症状无法从医学角度解释，几乎所有参与者都被贴上了抑郁症的标签。出现了四个主题，描述了他们如何体验职业倦怠的生活：“在世界上无家可归”、“诊断的局限”、“在公众眼中赤身裸体”以及“走向绝望之路”。我识别出两个主要问题；第一，患者对自身疾病的体验与医生对病情的解读之间的不匹配可能导致治疗无效。第二，受访者努力让自己被认可为患病。因此，生物医学范式中固有的价值观可能会对职业倦怠患者的医疗护理产生严重影响。
