Agotamiento profesional (burnout) en médicos intensivistas: una visión de la unidad de cuidados intensivos desde la teoría fundamentada

Abstract

IntroductionThe intensive care unit (ICU) is one of the most complex and costly services in the modern hospital. ICU implies pressures, frustrations, conflicts for the intensive care physician in an ever more stressful environment, with a tendency to develop occupational illnesses. One of these is burnout, comprised of emotional exhaustion, depersonalisation, and lack of personal accomplishment. There is a need to question ICU physicians on their perceptions about the specialty, the job, the very ICU where they work, or their outside environment, topics not so easily quantifiable. Grounded theory is proposed here to explore which structures or processes may promote burnout in them. Materials and methodsA qualitative study was conducted based on grounded theory, as proposed by Strauss and Corbin, under the suspicion of the genesis of burnout mediated by some inter-related features of a) specialty; b) equipment; c) hospital facility; d) environment. Theoretical sampling by convenience and structured interview with questions by blocks to intensive care physicians of Bogota⿿whether they be professors, physicians, residents. Audio transcription to Microsoft Word® 2013; information coded, classified with NVivo 10; contrast and saturation of information against previous ICU situation analyses published between 1995 and 2015. ResultsFourteen physicians were interviewed. According to them, ICU evolution and the Colombian General System of Social Security in Health define its present situation: a) strongly male specialty, reactive to Public Health problems (coronary disease, trauma, sepsis), mainly composed of anaesthesiologists and internists; b) huge dependence on health technologies, namely monitors and ventilators; c) lack of resources and structural improvisation in the hospital; d) concern about biological risks, worsened by occupational, administration risks⿿precarious work, lack of union, and fragile State, cohesion. Awareness of burnout is only seen through foreign literature, thus the physicians consider it as an unrelated issue. ConclusionsICU and intensive care practice in Colombia may reflect conditions of inequality towards the genesis of occupational illnesses. A social epidemiology focus is required to overcome ignorance on burnout, and other possibly conditions related to ICU.