Burnout is a multidimensional work-related syndrome that is characterized by emotional exhaustion, depersonalization—or cynicism—and diminution of personal accomplishment. Burnout particularly affects physicians. In medicine as well as other professions, burnout occurrence depends on personal, developmental-psychodynamic, professional, and environmental factors. Recently, it has been proposed to specifically define burnout in physicians as “pathology of care relationship.” That is, burnout would arise, among the above-mentioned factors, from the specificity of the care relationship as it develops between the physician and the patient. Accordingly, experimental studies and theoretical approaches have suggested that burnout and empathy, which is one of the most important skills in physicians, are closely linked. However, the nature of the relation between burnout and empathy remains not yet understood, as reflected in the variety of theoretical and contradictory hypotheses attempting to causally relate these two phenomena. Firstly, we here question the epistemological problem concerning the modality of the burnout-empathy link. Secondly, we hypothesize that considering the multidimensional features of both burnout and empathy, on one hand, and on the other hand, the distinction between empathy and sympathy enables to overcome these contradictions and, consequently, gives a better understanding of the relationship between burnout and empathy in physicians. Thirdly, we propose that clarifying the link between burnout, empathy and sympathy would enable developing specific training in medical students and continuous professional formation in senior physicians and would potentially contribute to the prevention of burnout in medical care.

Background: The French Universal Health Cover (CMU) aims to compensate for inequalities between precarious and non-precarious populations, enabling the former to access to free healthcare. These measures rely on the principle that precarious populations’ health improves if healthcare is free. We designed a study to examine whether CMU fails to compensate for inequalities in reimbursed drugs prescriptions in precarious populations. Material and method: This retrospective pharmaco-epidemiological study compared the Defined Daily Dose relative to different reimbursed drugs prescribed by general practitioners (GPs) to precarious and non-precarious patients in France in 2015. Data were analysed using Mann–Whitney tests. Findings: 6 out of 20 molecules were significantly under-reimbursed in precarious populations. 2 were over-reimbursed. The 12 remaining molecules did not differ between groups. Interpretation: The under-reimbursement of atorvastatin, rosuvastatin, tamsulosine and timolol reflects well-documented epidemiological differences between these populations. In contrast, the equal reimbursement of amoxicillin, pyostacine, ivermectin, salbutamol and tiopropium is likely an effect of lack of compensation for inequalities. Precarious patients are more affected by diseases that these molecules target (e.g., chronic bronchitis, bacterial pneumonia, cutaneous infections). This could also be the case for the equal and under-reimbursement of insulin glargine and metformin (targeting diabetes), respectively, although this has to be considered with caution. In conclusion, the French free healthcare cover does not fail to compensate for all but only for some selective inequalities in access to reimbursed drugs prescriptions. These results are discussed with respect to the interaction of the doctor–patient relationship and the holistic nature of primary care, potentially triggering burnout and empathy decrease and negatively impacting the quality of care in precarious populations.

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Background The association between precariousness and lack of access to health care is well-documented. Prescribing drugs is one promising marker for this health care inequality. A recent study, carried out on the entire French population, has developed a new measurement model based on the 20 most prescribed molecules. It reports that drugs, targeting diseases known to more affect precarious populations, are under-prescribed by general practitioners (GP) to these populations. If these findings highlight unequal drugs prescriptions between populations despite epidemiological factors, it is still unknown whether a high and daily exposure to precariousness negatively impacts GPs prescriptions. Here, we investigated whether there are more inequalities in prescriptions of GPs who are highly and daily exposed to precariousness, compared to GPs who are less exposed to precariousness. Methods This retrospective pharmaco-epidemiological study compared the Defined Daily Dose relative to different reimbursed drugs prescribed by GPs to precarious and non-precarious patients in four French regions respectively with low and high precariousness prevalence in 2015. Data were analyzed using repeated-measures ANOVAs (Sphericity correction: Greenhouse-Geisser; Post-Hoc Tests, Bonferroni corrected). Results 2 out of 20 molecules were significantly over-prescribed (tamsulosine and timolol) and 7 were under-prescribed (amoxicillin, econazole, ciclopirox, prednisolone, paracetamol, cromolyn sodium, ibuprofen) to precarious populations in regions with high precariousness prevalence. Conclusions The over-reimbursement of tamsulosine and timolol did not reflect the negative impact of exposure to precariousness on the GPs prescriptions but a failure of the health system to compensate for inequalities in access to chirurgical treatments. In contrast, the under-reimbursement of amoxicillin, ciclopirox and econazole indicated an effect of the exposure to precariousness on GPs’ prescriptions, these molecules targeting acute diseases that affect more significantly precarious than non-precarious populations. The same explanation is probably suitable for the under-reimbursement of prednisolone, paracetamol, cromolyn sodium, and ibuprofen, although their various indications render difficult to delimitate the clinical purpose at the basis of their prescription. We assume that exhausting working conditions, repeated exposures to difficult living conditions, and repeated experiences of failure impairs empathic skills in GPs, leading to burnout which negatively impacts the quality of care and, thus, prescriptions.

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