RevBrasAnestesiol.2015;65(4):237---239
REVISTA
BRASILEIRA
DE
ANESTESIOLOGIA
OfficialPublicationoftheBrazilianSocietyofAnesthesiology www.sba.com.brEDITORIAL
Occupational
wellbeing
in
anaesthesiologists:
its
relationship
with
educational
methodology
Bem-estar
ocupacional
em
anestesiologistas:
sua
relac
¸ão
com
a
metodologia
educacional
Thetimehascome!Itistimethatanaesthesiologistswake up to the pressing need of work satisfaction and posi-tive balance in life. Through various initiatives by WFSA (Professional Wellbeing Committee), ASA (Committee on OccupationalHealth)andSBA/CLASA,anesthesiasocieties all over the world are trying to create awareness on the BurningIssueofwellnessatwork.
‘‘With present interest in Weingology, that is the sci-enceofstudyingwell-being,atermcoinedbytheauthorsin anearlierchapter onOccupationalWellbeing,thepresent editorialisanattemptbytheProfessionalWellbeing Com-mitteeatWFSAtoidentifywithOccupationalWellbeing.In thesecondsectionofthiseditorial,wediscusstheroleof educationalmethodologiesinreducingstressandpromoting wellnessatwork.
Occupationalwellbeingmaybedefinedasastateofhigh jobsatisfactionandfulfillmentatwork.Itischaracterized byapositivejobengagementandavailabilityofadequate resourcestocopewithstressfulsituations.Asweet integra-tionofworkwithpersonallifethatprovidesagoodbalance andpersonal satisfactioncanleadtoan enhancedoverall wellbeing.
However, it is getting extremely difficult to provide a work environment that is completely free from physical andmental stress. Exposuretophysical agents like radia-tion/lasers/theaternoise/anestheticgases,riskofexposure to infections/contaminations, working in hostile environ-ments can all cause stress and affect the occupational wellbeing.
Someofthemoststressfulfactorsasperceivedby anes-thesiologists themselves are: lack of control over their workday,jeopardizedfamilylife,medicalandlegalaspects, communicationproblemsandclinicalproblems.Other fac-tors also reported are: work standards, management of critical patients, crisis management, dealing with death, problemsrelatedtoworkpattern(organizational), admin-istrative responsibilities, personal conflicts, conflicts in
professional relationships and conflicts outside the work environment.Amonganesthesiologyresidents,someofthe mainconcernsaremanagingcriticalpatients,dealingwith patients’ deaths and balancing personal life with profes-sionaldemands.
Lackofoccupationalwellbeingmaymanifestaslackof interestin work,absenteeism, dissatisfaction,low-quality work,possibilityofmedicalmalpractice(whichmayoccur throughnegligenceandresultinlegalproblems).Allthese situationsdenigratetheprofessionalsimageandmay some-timesresultincareerabandonment,prematureretirement and,inextremecases,civilorcriminalissuesthatcaneven leadtosuicide.
Failurein maintaining ahealthy relationship with chil-dren,disruptionoffamilylife,substanceabuse,depression, physicalandmentalimpairmentaresomeofthesocial con-sequences.Also,worthmentioninghereisthefactthatnot onlytheexternalfactors,butindividualcopingmechanisms and personality traits also determine the stress response fromdifferentindividualswhenfacedwithsimilarstressful situations. Primary personality traits like idealism, per-fectionism, timidity, insecurity, emotional instability and inability to relax can all weaken the coping ability to stress.Negative factorslike inadequateor lacking strate-giestodealwithstress,disappointedexpectations/negative experiences,inadequatesupportduetoalackofsocial rela-tionships/partnerships,lackofpatientgratitudeformedical careprovided,risksoflitigationcanalsoaffectour occupa-tionalwellbeing.
Hence, what we need at the individual level is the development of well functioning coping strategies. We have to train ourselves in identifying stressful factors at work. Next step can be to identify areas which we can modify to mitigate the stress effects. Development of positive job traits during anesthesiology training can alsocontributetowardahealthy,motivatedanesthetistof tomorrow.
http://dx.doi.org/10.1016/j.bjane.2015.04.001
238 EDITORIAL
As a resultof many factors includingthe high stresses
encounteredinthetypicaloperatingroom,theemotionally
debilitating consequences of being involved in a
periop-erative catastrophe, the increased fatigue of long work
hours, and a myriad of personality factors often found
inphysicians choosinganesthesiologyasa specialty,
anes-thesiologists are at high risk for burnout. Without coping
mechanismsofboth apersonal andinstitutionalnaturein
place, the physician withunrecognized burnout is at risk
of suicide and abuse of pharmaceutical agents as a form
ofself-medication.Inspiteofstrongevidencethatburnout
takesatremendoustollonanesthesiologiststhroughoutthe
world,apreviousWFSAsurveyofnationalanesthesia
soci-etiesbytheCommitteeonPhysicianWellnessindicatedfew
hadtakenevenminimal stepsfor developing methods for
activeinterventiontobreaktheun-wellnesscycleintheir
atriskmembers.
Thefirststepinpromotingwellnessamong
anesthesiolo-gistsistogainrecognitionthataproblemexists.Self-denial
isamajorproblemin deferringindividualphysicians from
seekinghelp,aswellasthefearofbeinglabeledasweakor unfitbycolleagues.However,significantdenialalsoexistsin
colleagueswhoareun-willingtorecognizeor reporta
fel-lowphysicianintrouble.Inorderforthemedicalcommunity
toeffectively deal withthe impaired physician,we need
toleave judgmentalattitudes behindandunderstandthat
activeintervention willnotonly helpthephysicianatrisk butalsothepatientswhoarebeingtreatedbythatimpaired
physician.Turning ablind eye to a physicianin need is a
directviolationofouroathtoallownoharmtocometoour patients.Themedicalliteratureaboundswithreportsofthe erosionofpatientsafetyandtheincreasesinmedicalerrors
associatedwiththeburnedoutandimpaired physician.In
orderfor theanesthesiacommunitytoembrace thisneed
fornon-judgmentalreportingoftheimpairedphysician,an
attitudechangeisneededwithinourmedicalcommunities
andstructuredprotocolsareneededwithinourinstitutions
allowing confidential reporting, with rapid and effective
interventiontopromotewellness.
The other key step to prevent physicians from sliding
downthesteep slopetoburnout, suicideandaddiction is
tomake them self-awareandinternally perceptiveofthe
stressesthattheyareunder.Teachingcopingtechniquesto
alleviatetheimpactofthestressesontheiremotional
well-beingcanbekeyinpreventinganindividualfromslidingto
thebottomofthatslipperyslopeofdepressionandburnout. Lifetechniquesofeatinganddrinkingproperly,getting
phys-icalexercise,having goodsleephabits, andmaintaininga
socialbalancewithfamilyandfriendswillallcontributeto
preventingun-wellnessfromdestroyingananesthesiologists
life.
Thegreatkeyfeatureneededinpreventinganaddicted
anesthesiologistfrombeingamortalitystatistic,isanactive
rehabilitationprocesssupportedbythemedicalcommunity.
As physician healers, who better to be in charge of our
ownwell-being?Oncerehabilitationhasoccurred,
depend-ingoftheformofaddiction,theanesthesiologistmayeither
re-enter the medical profession in anesthesiology or be
retrainedinsomeotherarea.Thekeypointisthatthe
train-ingandexpertise oftheanesthesiologist need notbelost
butratherutilizedandperhapsredirectedforthebenefitof boththeanesthesiologistandsociety.
InthiswaytheAmericanJointCommission---‘‘Sentinel
EventAlert’’urgesgreaterattentiontopreventingfatigue
anditsconsequences(BurnoutSyndrome,Chemical
Depend-ence,Suicidality,etc.)amonghealthcareworkersandthey
suggest specific actions for health care organizations in
ordertomitigatetheserisks.Thepurposeof‘‘SentinelEvent
Alert’’ is toaddress the effects and risksof an extended
workdayaswellasthecumulativeeffectofmanydaysof
extendedworkhours.The JointCommissionAlertmakesa
numberofrecommendationsforhealthcareorganizations,
such as medicalschools, medicaltraining centers, public
andprivatehospitals,nationalandregionalsocieties,
insur-anceinstitutionsandothers.Thespecificrecommendations
include:
1. Assessfatigue-relatedriskssuchasoff-shifthours, con-secutiveshiftworkandstaffinglevels;
2. Examine processes when patients are handed off or
transitionedfromonecaregiver toanother,a timeof
riskthatiscompoundedbyfatigue;
3. Seekstaffinputonhowtodesignworkschedulesthat
minimizethepotentialforfatigueandprovide
oppor-tunitiesforstafftoexpressconcernsaboutfatigue;
4. Createandimplementafatiguemanagementplanthat
include scientific strategies for fighting fatigue such
asengaginginconversation,physicalactivity,strategic
caffeineconsumptionandshortnaps;
5. Educatestaffabout goodsleephabitsandtheeffects
offatigueonsafetyofsurgicalpatients;
6. Determinefatigue-relatedriskssuchasoff-shifthours,
consecutiveshiftworkandstaffinglevels;
7. Examine processes when patients are handed off or
transitionedfromonecaregiver toanother,a timeof
riskthatiscompoundedwhenfatigueexists;
8. Seekstaffinputonhowtodesignworkschedulesthat
minimizethepotentialforfatigueandprovide
oppor-tunitiesforstafftoexpressconcernsaboutfatigue;
9. Createandimplementafatiguemanagementplanthat
includes scientific strategies for fighting it such as
engaging in conversation, physical activity, strategic
caffeine,consumptionandshortnaps;
10. Educate staff about good sleep and the effects of
fatigueonpatientsafety.
The Professional Committee of WFSA strongly
recom-mend the reading of the e-book‘‘(free downloadedfrom
de Home Pages of the World Federation of
Anesthesi-ologists WFSA), of the Latin-American Confederation of
AnesthesiologistsSocieties(CLASA)andBrazilianSocietyof
Anesthesiology(SBA).
Toconclude,weneedtobemoreaggressiveinformatting
medicaleducationregardingtheoccupationalhealthrisksof
physicians,specificallyinanesthesiologists,whichcanharm
theirhealthandwellbeing.Moreover,ithasbeenwell
doc-umentedthattheseriskstoanesthesiologistscanrepresent
seriousconsequencesforthesurgicalpatientsafety.
Nationalpoliciestopreventandhandletheburnout
syn-drome andrelatedpathologiesin health careprofessional
also must be developed throughthe Programs of Medical
EDITORIAL 239
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
Recommended
references
1.Gupta P, Nuevo F. Burnout syndrome in anaesthesiologists ---theactualreality.In:NetoGFD,editor.Occupationalwellbeing in anaesthesiologists. Rio de Janeiro: Sociedade Brasileira de Anestesiologia/SBA;2014.,ISBN978-85-98632-24-7.
2.TorchiaroGC.Evaluationofanesthesiologistsoccupational well-being around the world. In: Neto GFD, editor. Occupational wellbeing in anaesthesiologists. Rio de Janeiro: Sociedade BrasileiradeAnestesiologia/SBA;2014.,ISBN978-85-98632-24-7.
3.ImprovingPatientandWorkerSafety.TheJointCommission SEN-TINELALERT---FatigueOpportunitiesforSynergy.Collaboration andInnovation;2012,November19.
4.Healthcareworkerfatigueandpatientsafety;2011,December 14.
PratyushGupta,RogerMoore, GastãoF.DuvalNeto∗
MembersoftheProfessionalWellbeingCommittee
(WFSA),Brazil
∗Correspondingauthor.
E-mail:gduval@terra.com.br(G.F.DuvalNeto).
