Sociedade Brasileira de Anestesiologia Conselho Federal de Medicina Occupational Well-being in Anesthesiologists Editor Gastão F. Duval Neto Rio de Janeiro 2014 Copyright © 2014 – Brazilian Society of Anesthesiology Brazilian Society of Anesthesiology Rua Professor Alfredo Gomes, 36 Botafogo – Rio de Janeiro/RJ CEP 22251-080 Phone: 55 21 3528 1050 Fax: 55 21 3528 1099 E-mail: [email protected] Federal Council of Medicine of Brazil SGAS 915, lote 72 – CEP 70390-150 – Brasília/DF Phone: 55 61 3445 5900 – Fax: 55 61 3346 0231 E-mail: [email protected] Publication also available at: http://www.portalmedico.org.br Editorial Board Antônio Fernando Carneiro Desiré Carlos Callegari Hammer Nastasy Palhares Alves Ronaldo Laranjeira Institutional Support Brazilian Society of Anesthesiology (Sociedade Brasileira de Anestesiologia (SBA)) Federal Council of Medicine of Brazil (Conselho Federal de Medicina (CFM)) Latin American Confederation of Societies of Anesthesiology (Confederacion Latinoamericana de Sociedades de Anestesiología (Clasa)) World Federation of Societies of Anaesthesiologists (WFSA) Supervision – Maria de Las Mercedes Azevedo Supervision/Review/Translation – Getulio Rodrigues Oliveira Filho, Gabriela Nerone, Maria Eduarda Brinhosa, João Felipe Locatelli Graphic design and layout– Marcelo de Azevedo Marinho S678o Occupational Well-being in Anesthesiologists / Editor: Gastão F. Duval Neto. Autores: Gastão F.Duval Neto et al. Rio de Janeiro: Sociedade Brasileira de Anestesiologia/SBA, 2014. 286 p. ISBN 978-85-98632-24-7 1- Occupational health and principles. 2- institutional responsabilities and physicians. 3- Biological hazards. 4- interdisciplinar aspects of occupational well-being. I – Duval Neto, Gastão F. CDD 617.96 Summary Presentation ...............................................................................05 Preface SBA ...............................................................................07 Preface WFSA .............................................................................09 Introduction ..............................................................................11 Part 1 - Principles and basis of occupational health .........................................13 1.1 Evaluation of anesthesiologists occupational well-being around the world ........................15 Gustavo Calabrese Torchiaro 1.2 The stress caused by medical emergencies. Fatigue and its correlation with diseases, suicide and medical malpractice .................................................................................37 Flavio Veintemilla Sig - Tú 1.3 Factors involved in the development of chemical dependency in anesthesia personnel ............57 Roger Addison Moore 1.4 Burnout syndrome in anaesthesiologists- the actual reality .......................................97 Pratyush Gupta e Florian Nuevo 1.5 Measuring professional well-being among anesthesiologists: Conceptual structures and attributes of the instruments ........................................................................119 Getúlio Rodrigues de Oliveira Filho 1.6 Anesthesiology residents – The importance of occupational well-being ..........................127 Maria-Helena Arenson Pandikow e Florentino Fernandes Mendes 1.7 The Professional well-being of anesthesiologists .................................................143 Pirjo Lindfors Part 2 - Institutional responsibility for physician (anesthesiologist) occupational well-being. .165 2.1 Correlation between anesthesiologists’ occupational well-being and surgical patient safety ......167 Gastão Fernandes Duval Neto Part 3 - Biological risks and occupational health ...........................................191 3.1 Radioprotection for anesthesiologists ...........................................................193 Antonio Fernando Carneiro e Onofre Alves Neto 3.2 Mechanical occupational risks in anesthesiology ................................................199 Antenor de Muzzio Gripp e Luiza Alves de Castro Arai 3.3 Ergonomic occupational risks in anesthesiology .................................................207 Luiz Alfredo Jung 3.4 Biological occupational risks in anesthesiology ..................................................221 Antonio Fernando Carneiro e Fabiana Ferreira AP Bosco Bosco 3.5 Exposure to inhaled anesthetics .................................................................231 Maria Angela Tardelli, Carlos Rogério Oliveira Degrandi e Edno Magalhães 3.6 Exposure to chemical agents ....................................................................243 Rogean Rodrigues Nunes e Cristiane Gurgel Lopes Farias 3.7 Sharps injuries: Guidance for the anesthesiologist ...............................................253 Oscar César Pires Part 4 - Interdisciplinary aspects of occupational health ...................................257 4.1 Addiction among anesthesiologists: from diagnosis to intervention. .259 Hamer Nastasy Palhares Alves, Luiz Antonio Nogueira Martins, Daniel Sócrates e Ronaldo Larnajeira 4.2 Ethical and legal aspects of medical malpractice .................................................277 Desiré Carlos Callegari Presentation The occupational health and welfare of Brazilian physicians are points of concern of the Federal Council of Medicine (CFM). Nowadays, we live in times of great social, cultural, economic and political changes that directly impact on the physician- patient relationship, on the way medicine is exerted and on personal and professional lives of colleagues who fulfill their mission in hospitals, emergency rooms, and out- patient facilities. In general, the absence of public policies that value the role of the doctor in assistance associated with the lack of investment in health eventually produce a scenario of dis- incentive and pressure on the professional who, unfortunately, in some situations, becomes victim of this neglect. Amid the real needs of patients and the indifference of the managers, the doctor has been pushed towards the brutalization of his/her postures, physical and emotional distress and the search for inadequate solutions to mitigate daily difficulties. This issue assumes relevant proportions among anesthesiologists due to the char- acteristics of the specialty. However, the phenomenon is not isolated and should be treated. Aware of the implicit severity of this fact, the CFM - in an unprecedented partnership with the Brazilian Society of Anesthesiology (SBA) - created a National Commission for Ethics and Medical Assistance to the Chemically Dependent Physi- cian Patient, announced at the conclusion of the First International Symposium on Occupational Health of Anesthesiologists, held in Brasilia in September 2013. This book is one of the first products of this group. The compiled articles provide data relevant to the formulation of a diagnosis of the problem and suggest paths for future coping strategies. At first, anesthesiologists make up the focus group, but soon it is expected these benefits and services are expected to be extended to the entire population of physicians. As occurred with a similar initiative, conducted by the Regional Medical Council of the State of São Paulo (Cremesp), which served as a mirror to the current proposal, both SBA and CFM are confident that they can contribute decisively to assist physi- cians in crisis, giving them new opportunities. Thus, our entities will make a differ- ence as supports to rebuilt lives and careers. Luiz Roberto d’ Avila Desiré Carlos Callegari President of CFM First secretary of CFM Presentation | 5 Preface by the Brazilian Society of Anesthesiology The Brazilian Society of Anesthesiology (SBA) provides its members - and the medi- cal literature - with this book on the conditions necessary to ensure a high degree of safety and quality of life at work, calling into attention the urgent need for protecting the health of physicians, teaching to promote physical, mental, social and moral wel- fare, as well as the prevention, detection, approach / treatment measures and control of accidents and / or illnesses resulting from the practice of medicine, thus enabling the reduction of risky situations. We can say that the Commission on Occupational Health of the SBA reaches his majority at this time, when it overcomes the internal perimeters of anesthesia and, in partnership with the Federal Council of Medicine, the Latin American Confedera- tion of Societies of Anesthesiology and the World Federation of Societies of Anaes- thesiologists, envisions, designs and implements the description of many relevant topics to the health of physicians in a single book, published in three languages - Portuguese, Spanish and English . We have effective awareness of the importance of this book, which is why it has become so pleasurable. We hope to raise the readers understanding of the need for changes in personal attitudes, especially toward their behaviors in hospitals, clinics and at home, enabling them aided by the recommendations contained in this publi- cation, to achieve professional welfare associated with personal happiness. Airton Bagatini President of the Brazilian Society of Anesthesiology, 2013 Preface SBA | 7 Preface WFSA All people will experience stress during their lives. Stress after all is concomitant with modern living and whatever your job, it is likely that you will suffer moments of extreme stress. Sadly this seems to be beginning in childhood and when at school pressures are applied to ‘succeed’ and ‘do well’ by being able to paint, read, play a musical instrument and act in a