Interestingly, as the two papers by Leone et al. and Armon
et al. illustrate, prolonged fatigue and factors contributing to
fatigue are crucial in both the promotion and ability to
recover from burnout [21,22]. The Leone et al. study
supports the notion that burnout must be examined and
treated within the context of potential comorbidities. For
instance, when it occurs in conjunction with extra-occupational
sources of fatigue, there is evidence that the management
of burnout is more challenging than when burnout is
solely a consequence of the work environment. This study
demonstrated that those both burned out and fatigued from
other causes exhibited much higher rates of a chronic course
than those who were only fatigued or only burned out. This is
analogous to those patients who complain of sleepiness who
have two small contributing reasons for their sleepiness.
Either reason on its own may have little impact and not
require treatment, but the two factors impacting the
individual concurrently have what appears to be a multiplicative
effect leading to significant disability.