Introducción

El Síndrome de "Burnout", también llamado Síndrome de Agotamiento Profesional, considerado según la OMS, como de riesgo laboral, causa detrimento en la salud mental del trabajador de la salud que lo presenta, así como síntomas físicos. Este síndrome se define como una respuesta al estrés crónico y sostenido del ambiente laboral, integrado por actitudes y sentimientos negativos hacia las personas con las que se trabaja y hacia el rol profesional, así como por la vivencia de encontrarse emocionalmente agotado. Se presenta frecuentemente en profesionales de la salud, y en general en aquéllos que laboran en organizaciones de servicios y que están en contacto directo con personas que se encuentran en situación de dependencia o necesidad. La causa de este síndrome se sabe que son los factores viciados de la organización misma, por ejemplo, sobrecarga de trabajo, injusticia, falta de recompensa por el trabajo desempeñado, conflicto con los valores, pérdida de la cordialidad en el ambiente laboral y pérdida de control sobre lo que se realiza, ya que los principios de la administración de hospitales, supone que tiene que existir una carga de trabajo conforme a indicadores de productividad y calidad, que exista justicia, reconocimiento al trabajo desempeñado, estímulos y recompensas, todo esto dentro de un ambiente laboral armónico, que permite la comunicación entre todos los niveles y favorece el desarrollo empresa-trabajador.

Para diagnosticar el síndrome se utiliza el cuestionario de Maslach. Cuando la psicóloga Cristina Maslach informó sobre este síndrome y realizó el cuestionario (1976) se iniciaron las investigaciones en Estados Unidos y en Europa en áreas de la salud para identificar dicho síndrome.

Con el fin de determinar y evaluar los factores organizacionales asociados al "Síndrome de Burnout" se realizó este estudio en los médicos anestesiólogos de la ciudad de Mexicali, B.C., México.

Material y métodos

Estudio de casos y controles. El grupo de casos estuvo constituido por los sujetos que presentaron el síndrome y el grupo control por los que no lo presentaron. El tamaño de la muestra fue de n=28. Las variables independientes fueron los factores viciados de la organización. Los instrumentos validados que se utilizaron fueron el cuestionario de Maslach para identificar el síndrome y el cuestionario general para identificar los factores de riesgo. Análisis estadístico utilizado: estadísticas descriptivas, prueba de proporciones para dos poblaciones, razón de momios cruda y ajustada, chi cuadrada y análisis de regresión logística (BMDP y Epi Info 6).

Resultados

Se determinó la prevalencia del síndrome de "burnout", excluyéndose a tres médicos que se rehusaron a contestar los cuestionarios y de los 89 sujetos analizados se obtuvieron 37 casos, dando como resultado una prevalencia general de 44%. El grupo de casos estuvo constituido por 23 hombres y cinco mujeres; el grupo control por 19 hombres y 9 mujeres (p>0.05). La edad promedio en el grupo de casos fue de 43.7 años; en el grupo control 45.8 años. El estado civil en el grupo de casos es de 85.7% casados, 7.1% divorciados, 3.5% vive en unión libre, y 3.5% es soltero. En el grupo control hubo 71.4% casados, 14.3% solteros, 7.1% viudos y 7.1% en unión libre. En cuanto a los años que llevaban laborando, la máxima antigüedad para el grupo de casos fue de 24 años y la mínima de dos años con una media de 13.5 años; en el grupo control la antigüedad máxima fue de 28 años, la mínima de dos años y la media de 16.4 años. Para las variables de estudio se obtuvo para sobrecarga de trabajo p = <0.003 y para la variable de conflicto con los valores p = <0.034; las demás variables no fueron significativas, y para las variables no organizacionales, se detectó que el estar casado o divorciado y el tener hijos son factores de riesgo para presentar el síndrome.

Discusión

Los resultados obtenidos en relación con la sobrecarga de trabajo, coinciden con lo documentado en la bibliografía, donde refieren ser el factor organizacional viciado que más afecta a la población que presenta el síndrome, en relación con los conflictos con los valores, que resultó ser significativa, coincide con lo reportado por Maslach; este fenómeno ocurre cuando no hay correlación entre la demanda del trabajo y los principios morales, que en nuestro estudio mostró tener un factor protector, es decir la actitud que asumen las personas para tratar de protegerse contra el agotamiento y la decepción, y que se traduce en cinismo.

Se requieren nuevas líneas de investigación, puesto que a medida que el médico goce de buena salud tanto mental como física, será posible brindar una atención de calidad, además se necesita el conocimiento de las organizaciones de salud, en relación con este síndrome, ya que de no tenerlo, contribuye a que cuando se presente no se le diagnostique oportunamente. Los signos y síntomas del síndrome de "burnout" pueden ser confusos en los médicos con falta de motivación para el trabajo, y por ende se les puede calificar como perezosos, irresponsables y conflictivos, cuando en realidad están enfermos, y necesitan un apoyo. El desconocimiento del síndrome por parte de los médicos y de los directivos de las organizaciones de salud, dificulta el contar con apoyo para continuar con estas investigaciones.

Introduction

Burnout Syndrome is considered by the WHO as a worker's risk, that causes mental and physical deterioration (headaches, gastrointestinal illness, high blood pressure, muscular tension and chronic fatigue). This is a result of chronic stress and of the workplace environment, which today is cold, hostile, demanding, both economically and psychologically. People are becoming cynical, with negative feelings toward their patients and their professional roll; they feel emotional exhaustion. This occurs frequently in health workers who deal with people who are dependent.

What is the cause of this syndrome that is damaging the community of the workers? It is due to many facts, such as organizations where there is work overload (workload is a dimension of organizational life, this means productivity. In their scramble for increased productivity, organizations push people beyond what they can sustain, making work more intense, demanding more time and becoming more complex; this is the major risk factor, in which is shown an uncorrelation between the people and their work); lack of control (of the capacity to set priorities in their own work, to select and to make decisions regarding resources that are central in the professional roll; politics of the organization that interfere with this capacity, reduce individual autonomy an involvement with work); lack of reward (lack of community harmony, lack of fairness and also value conflict); breakdown of community (the loss of harmony in the community is made evident by greater conflicts among people, less mutual support and respect, and a growing sense of isolation); absence of fairness (trust, openness and respect, are all three, elements of fairness essential to maintain a person's engagement with work. Their absence contributes directly to burnout); conflicting valúes (this occurs when there is no correlation between the sources of workplace and the personal values, in some cases work overload makes people work with no ethics, causing them conflict with their own values).

This syndrome has three dimensions: Exhaustion. When people experience exhaustion, they feel overextresed, both emotionally and physically; they feel drained, unable to recover, they don't sleep enough, and lack of energy needed to face new projects. Exhaustion is the first reaction to the stress of job demands or major change.

Cynicism. They take a distant attitude toward work and the people on the job. They minimise their involvement at work and even give up their ideals. In some way, this is a form of protecting themselves from exhaustion and disappointment, persons feel it's safer to be indifferent, especially when the future is uncertain. Such a negative attitude can seriously damage a person's well-being and capacity to work.

Ineffectiveness. Persons feel a growing sense of inadequacy, every project seems overwhelming, they think everybody conspires against them, and whatever they do, seems to be trivial. They lose confidence in themselves, and at the same time, others lose confidence in them. They become vulnerable to family strangements, and to abandon social activities, they tend to remain alone. By this time they can incur in drug abuse, become mentaly insane, and in extreme cases, comit suicide.

The measurement instrument for the diagnosis of Burnout Syndrome is Maslach Burnout Inventory, which allows to sample large populations under this condition; it was developed by Maslach in 1976, and a large number of studies have been developed by this time.

Chronic stress could have important effects on the quality of family relationships and have a negative influence in anesthesiology performance as well.

Because of this important problem that affects physical condition of illness, mental health and performance and quality of medical services, and also because there are no studies in the anesthesiologist environment, we performed this study to asses burnout among anesthesiologist in the city of Mexicali, Baja California.

The object of this study was to determine and evaluate the organizational factors associated to burnout, because anesthesiologist performs at surgery rooms, where they have to manage chronic and sustained stress; moreover they get involved with patients, and are exposed to organizational factors. Burnout may affect mental health, and thus, the performance of the anesthesiologist practice, fact that even may put in serious risk the life of patients.

Material and methods

Control and cases study was performed, universe included all anesthesiologist in Mexicali City (n=92), excluding thoses that are not active in anesthesiologist practice, and who refused to respond the surveys. Cases group was constituted by anesthesiologists with burnout syndrome and control group was constitute by anesthesiologists without burnout. Sampling was obtained by Cochran's formula obtaining n=28 for each group. Independent variables were vicious organizational factors (work overload, lack of control, lack of reward, breakdown of community, absence of fairness, conflicting values). Dependent variable was Burnout Syndrome. Valídate instruments use were Maslach's Inventory for diagnosis of Burnout and a general sociodemographic inventory, for risk factors.

Statistic analysis performed were descriptive analysis, proportion tests for two populations, Odds ratios, and Chi², at the same time Logistic regression was performed, the statistic program use was BMDP and Epi Info 6.

Results

First of all, we estimated the prevalence of burnout, excluding three anesthesiologists that refused to answer the inventory test, of 89 persons analyzed we obtained 37 cases, that gives us a prevalance of 44%. The group case was constituted by 23 males and five females, control group by 19 males and 9 females (p>0.05). Mean age of case group was 43.7 years; control group 45.8 years. Civil state for cases group was 85.7% married, 7.1% divorced, 3.5% single, 3.5% not married couple, for control group 71.4% married, 14.3% single, 7.1% widows and 7.1% not married couple; working time for case group range from 24 years to two years, mean age 13.5 years, control group range from 28 years to two years, mean age 16.4 years. For no organizational factors, being married or divorced was a risk for burnout with OR 5.20, having children's was a risk for burnout with OR 33.2, and having more years at work was also significant for developing burnout with OR 1.17.

For organizational factors, the two variables for risk for burnout were work overload with p = 0.003, and conflicting values with p = 0.034, the other factors were no significant.

Discussion

The most important findings of the present study, were that work overload is a factor risk for burnout, this agrees with literature reports, where it is said that work overload is the factor that most affects health workers. In relation to conflicting values it also agrees with Maslach's studies, where the author says that this occurs where there is no correlation between work demand and moral values. In most cases, work overload can lead people to act with no ethics in their work, this creating conflicts with their moral values.

In this study conflicting values result in being an protecting factor, considering Maslach's publishing, this is a form that health workers assume to try to protect themselves against exhaustion and deception, thus adopting the form of cynicism.

The sieges we can find in this study is the honesty in the answers of the persons, besides this is assume by the inventory, this exist. Another siege is the sample size, but this was affront by an statistic manner.

It is so important to continue with new investigation lines, because as long as a medical doctor has good mental and physical health, he will be apt to give qualified attention to patients.

At the same time is important that organizations recognize this health problem, so they can provide psychiatric intervention for those medical doctors who are affected by this syndrome, and try also to reestructure their organization in order to avoid this problems.