Síndrome de burnout en médicos y personal paramédico

SUMMARYIntroductionBurnout syndrome is one of the most studied manifestations of jobstress. The burnout concept was used by the first time in the area ofpsychology by Freudenberger in 1974. This psychologist defined itas a condition of fatigue or frustration that is produced by thecommitment to a reason, lifestyle or relationship that does not producethe expected effort. Afterwards, Maslach and Jackson proposed threeinterrelated dimensions: emotional weariness (EW) which estimatesthe experience of emotional fatigue for the demands of work; thedepersonalization (DP) which measures the answers of impersonaltype and negative attitudes towards the patients; and the personalaccomplishment (PA) which reflects the personal satisfaction and thecompetition in the practice of the daily work. These dimensions arejoined in the Maslach Burnout Inventory (MBI) that is used to measurethe afore mentioned syndrome.Several studies have demonstrated the presence of burnoutsyndrome among medical and paramedic personnel. The closecontact with the patients and the work overload are the main reasonsof this syndrome. In a multicentre study carried out among 248 doctorsof the United States, 40% presented the syndrome with emotionaldetriment, which coincides with another study carried out with nursesattending patients with palliative care and marrow transplants.Also, in a study carried out among residents of internal medicineof the University of Washington, there was a prevalence of 76% ofprofessional wear, with an autoperception of a lower quality in theprofessional care of the patients, after comparing them with non-affected residents. In Mexico, a study that investigated burnout levelin a group of 450 medical practitioners, nurses and paramedics of12 institutions revealed the following information: 10.9% presentedemotional weariness, 19.6%, depersonalization, and 74.9, lowpersonal accomplishment. Palmer et al. determined a generalprevalence of 44% of the syndrome in anesthesiologists. The workoverload and the conflict of values were variables that influenced thepresence of this syndrome. At the Instituto Mexicano del Seguro Social,Aranda et al. carried out a study among family physicians, where theprevalence of burnout syndrome was 42.3%. Likewise, Cabrera etal. found that, out of 236 studied nurses, 92 (39%) had informationcompatible with burnout syndrome, with statistically significantdifferences for the age and the antiquity in the place after comparingthem with nurses without burnout syndrome.The burnout syndrome was considered by the World HealthOrganization as work risk. Its trascendence is rooted in the impact ithas in the labor relation between medical and/or paramedicpersonnel and the health institutions. For this reason, we consideredit important to investigate the presence of this syndrome among themedical and paramedic personnel working at hospital of the Mexicansocial security.Materail and MethodsDesign: Transversal comparative survey.Population: Of a total population of 240 workers of the healtharea assigned to a general hospital a sample of 160 was obtainedthat included doctors, nurses and medical assistants based on anaverage prevalence of the syndrome in 30%, with an alpha level of0.05 and a power of 90%. Instrument of evaluation: The survey was based on thefollowing sociodemographic and labor variables: age, marital status,academic level, labor antiquity, antiquity of adscription to the hospital,category, service and labor shift.To evaluate the burnout syndrome, the MBI questionnaire wasused in its previously validated Spanish version. The afore mentionedinstrument is an objective way of measuring and determining theburnout level that a person experiences, in its three subscales: EW,DP and PA. The survey consists of 22 items with a Likert typepunctuation scale (0-6), of which 9 valued EW, 5, DP, and 8, PA. Withregard to the EW, which values the sensation of being emotionallyexhausted by the daily contact with people to whom it is necessary toattend as object of work, a punctuation of 27 or higher indicated ahigh level; between 19 and 26, moderated; and lower than 19, low.In the subscale DP, which measures the degree in which the responsetowards the patients is cold, distant and impersonal, punctuationsabove 10 indicated a high level; from 6 to 9, moderated; lower than6, low. In the subscale PA, which values the feelings of competitionand efficiency for the accomplishment of the work and the relationwith the people who are being attended, values above 40 indicatedpersonal high accomplishment; from 34 to 39, intermediate; andunder 33, low. In the case of obtaining a low emotional depletion, alow depersonalization and a high personal accomplishment, it wasconsidered that no burnout was present. In the rest of the cases, thepresence of burnout syndrome was established.Compilation of the information: From August to December,2005, the survey was applied to each of the workers, indicating them