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Invited Commentary
August 2018

Burnout and Depression Among General Surgery Residents: Image Is Everything—It Alters Perception

Author Affiliations
  • 1Department of Vascular and Endovascular Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
JAMA Surg. 2018;153(8):711. doi:10.1001/jamasurg.2018.1003

In this issue of JAMA Surgery, Williford et al1 report that general surgery residents in North Carolina demonstrated signs and symptoms of burnout (75%) and depression (40%). This finding is probably not different in other states and other general surgery programs. This is not news for many of us, because burnout and depression have been identified as problems with surgeons since 2009.2 The unique finding in this study is that the perception by general surgery residents and faculty members was significantly better than what was found to be true. Why would that be? We are great clinicians; why can we not see this in each other?

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2 Comments for this article
Terence Quigley, MD, FACS | Clin Assoc Prof University of Washington
I think Dr. Freischlag captures the essence of burnout in General Surgery very well....it starts in residency but is applicable throughout one's career......however, it is not a specialty specific, profession specific or gender specific issue acknowledging that job specific stresses and biology are important variables.....it's just that some people cope better than others - I have and continue to see it in my colleagues, patients and family.....for the most part burnout occurs in those less able to cope - it is NOT a weakness or personality deficit, but simply a personality trait that should be recognized so that adaptive mechanisms can allow a fulfilling career and life.......a career surgery is not for everyone, nor is public speaking, law enforcement, or serving in the military among other "stressful" careers.....Coping is also a life skill that can be improved with education and adaptation.
Jousting at windmills
Paul Cunningham, MD | The Brody School of Medicine at East Carolina University
Thank you Dr. Freischlag!
I am wondering if there is a dimension to this that needs some consideration.

It appears that the early expectations that are harbored in the heart of our trainees are confounded and frustrated by their subsequent real life experiences.
Is there anything that we could possibly do to match expectation with the realities that we all face in our contemporary practices?

I often muse about our surgical colleagues across the globe who are likely to be just as challenged as we feel, perhaps more so, and yet are coping. Is it that
their expectations are better matched by their real life experiences? Is it that they have more autonomy, that matches more accurately with their authority? Is it that their "accountabilities" are more realistic, and are linked with a more felicitous celebration, versus an accustomed end point for damning critique?

Ultimately, I am thinking, if our expectations match the product of our labor more precisely, the "burnout phenomenon" would not exist.