{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T16:44:09Z","timestamp":1788367449258,"version":"build-2803163510"},"reference-count":25,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Med Humanities"],"accepted":{"date-parts":[[2022,11,16]]},"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:p>This paper examines the topic of physician burn-out from a philosophical lens. We explore the question of how the rise of physician burn-out may be related to an underlying erosion of meaning in medicine, characterised by the breakdown of the intersubjective relationship between doctors and patients. We argue that while commonly cited strategies for addressing burnout\u2014including promoting work-life integration, cultivating workplace community, and fostering resilience\u2014are critical for enhancing physician well-being, the common thread linking these approaches is that each identifies the physician as the primary locus of intervention. We propose that physician-centric approaches alone may be insufficient in addressing burnout, as the work might also involve shifting our attention to the intersubjective space that exists between the physician and the patient. To further elucidate the connection between intersubjectivity and the creation of meaning in medicine, we call on twentieth-century philosopher Emmanuel Levinas. Applying Levinas\u2019s philosophy to the clinical context, we discuss the phenomenon of \u2018depersonalisation\u2019 and ask whether, rather than a mere consequence of burnout, depersonalisation might be a core cause of this condition. With these points we shed light on an idea that is relatively absent from the burn-out literature: that a person-oriented approach is vital not only for patient well-being but for physician wellness as well, as a process that \u2018de-personalizes\u2019 patients might result in a simultaneous dehumanisation of physicians themselves. Drawing inspiration from Levinas, we explore how a reorientation towards the intersubjective, dialogical dimension of the doctor-patient dyad could serve as one important ingredient in healing not only the patient, but the physician as well.<\/jats:p>","DOI":"10.1136\/medhum-2022-012506","type":"journal-article","created":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T13:21:05Z","timestamp":1671196865000},"page":"390-395","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Erosion of the \u2018ethical\u2019 doctor-patient relationship and the rise of physician burn-out"],"prefix":"10.1136","volume":"49","author":[{"given":"Atara","family":"Messinger","sequence":"first","affiliation":[{"name":"Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunit","family":"Das","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery and Centre for Ethics, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,12,16]]},"reference":[{"issue":"1","key":"2025092411410186000_49.3.390.1","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s41687-020-00204-x","article-title":"\u201cDescribing the Emotional Exhaustion, Depersonalization, and Low Personal Accomplishment Symptoms Associated with Maslach Burnout Inventory Subscale Scores in US Physicians: An Item Response Theory Analysis.\u201d","volume":"4","author":"Brady","year":"2020","journal-title":"Journal of Patient-Reported Outcomes"},{"key":"2025092411410186000_49.3.390.2","unstructured":"Broyard A . 1993. Intoxicated by My Illness: And Other Writings on Life and Death. New York: Fawcett Columbine."},{"issue":"2","key":"2025092411410186000_49.3.390.3","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s10459-018-9824-3","article-title":"\u201cThree Visions of Doctoring: A Gadamerian Dialogue.\u201d","volume":"24","author":"Chin-Yee","year":"2019","journal-title":"Advances in Health Sciences Education"},{"key":"2025092411410186000_49.3.390.4","unstructured":"Chohan K. , Fetzer K. , Heiser S. R. , and Norman S. . 2020. \u201cFrom Burnout to Wellness: Using Appreciative Inquiry to Shift MidMichigan Health towards a Strengths-Based Perspective.\u201d Master of Applied Positive Psychology (MAPP) Service Learning Projects."},{"key":"2025092411410186000_49.3.390.5","doi-asserted-by":"crossref","unstructured":"Cohen R. A . 1986. Face to Face with Levinas. Albany: State U. of New York P.","DOI":"10.1353\/book10964"},{"key":"2025092411410186000_49.3.390.6","doi-asserted-by":"crossref","unstructured":"Cooperrider D. L . 2017. \u201cThe Gift of New Eyes: Personal Reflections after 30 Years of Appreciative Inquiry in Organizational Life.\u201d Research in Organizational Change and Development.","DOI":"10.1108\/S0897-301620170000025003"},{"key":"2025092411410186000_49.3.390.7","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-138-9-200305060-00028"},{"key":"2025092411410186000_49.3.390.8","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyp180"},{"key":"2025092411410186000_49.3.390.9","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000582"},{"key":"2025092411410186000_49.3.390.10","unstructured":"Levinas E . 1998. Entre Nous: On Thinking-of-the-Other. London: Athlone Press."},{"key":"2025092411410186000_49.3.390.11","unstructured":"Levinas E . 2013. Totality and Infinity: An Essay on Exteriority. Pittsburgh, Pa: Duquesne University Press."},{"key":"2025092411410186000_49.3.390.12","unstructured":"Levinas E . 2016. Otherwise than Being, or, Beyond Essence. Pittsburgh, Pa: Duquesne University Press."},{"key":"2025092411410186000_49.3.390.13","unstructured":"Levinas E. , and Nemo P. . 2011. Ethics and Infinity: Conversations with Philippe Nemo. Pittsburgh: Duquesne University Press."},{"key":"2025092411410186000_49.3.390.14","unstructured":"Maslach C. , Jackson S. E. , and Leiter M. P. . 2018. Maslach Burnout Inventory: Manual. Menlo Park, Calif: Mind Garden."},{"issue":"12","key":"2025092411410186000_49.3.390.15","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.28780","article-title":"\u201cAssociation of Physician Burnout With Suicidal Ideation and Medical Errors.\u201d","volume":"3","author":"Menon","year":"2020","journal-title":"JAMA Network Open"},{"issue":"4","key":"2025092411410186000_49.3.390.16","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1097\/01.ACM.0000659780.78558.71","article-title":"\u201cCommentary on Laoco\u00f6n Group.\u201d","volume":"95","author":"Messinger","year":"2020","journal-title":"Academic Medicine"},{"key":"2025092411410186000_49.3.390.17","doi-asserted-by":"publisher","DOI":"10.1023\/A:1022534902202"},{"issue":"11","key":"2025092411410186000_49.3.390.18","doi-asserted-by":"crossref","first-page":"98","DOI":"10.3390\/bs8110098","article-title":"\u201cFactors Related to Physician Burnout and Its Consequences: A Review.\u201d","volume":"8","author":"Patel","year":"2018","journal-title":"Behavioral Sciences"},{"key":"2025092411410186000_49.3.390.19","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1385"},{"key":"2025092411410186000_49.3.390.20","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2012.3199"},{"issue":"1","key":"2025092411410186000_49.3.390.21","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.mayocp.2016.10.004","article-title":"\u201cExecutive Leadership and Physician Well-Being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout.\u201d","volume":"92","author":"Shanafelt","year":"2017","journal-title":"Mayo Clinic Proceedings"},{"issue":"9","key":"2025092411410186000_49.3.390.22","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1016\/j.mayocp.2018.10.023","article-title":"\u201cChanges in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017.\u201d","volume":"94","author":"Shanafelt","year":"2019","journal-title":"Mayo Clinic Proceedings"},{"issue":"10057","key":"2025092411410186000_49.3.390.23","doi-asserted-by":"crossref","first-page":"2272","DOI":"10.1016\/S0140-6736(16)31279-X","article-title":"\u201cInterventions to Prevent and Reduce Physician Burnout: A Systematic Review and Meta-Analysis.\u201d","volume":"388","author":"West","year":"2016","journal-title":"Lancet (London, England)"},{"key":"2025092411410186000_49.3.390.24","doi-asserted-by":"publisher","DOI":"10.1111\/joim.12752"},{"key":"2025092411410186000_49.3.390.25","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1716845"}],"container-title":["Medical Humanities"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/medhum-2022-012506","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T18:41:10Z","timestamp":1758739270000},"score":1,"resource":{"primary":{"URL":"https:\/\/mh.bmj.com\/lookup\/doi\/10.1136\/medhum-2022-012506"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,16]]},"references-count":25,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,8,24]]},"published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1136\/medhum-2022-012506"],"URL":"https:\/\/doi.org\/10.1136\/medhum-2022-012506","relation":{},"ISSN":["1468-215X","1473-4265"],"issn-type":[{"value":"1468-215X","type":"print"},{"value":"1473-4265","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,16]]}}}