Brazilian intensivists: exhausted, but (still) happy with their choice?

Burnout syndrome has gained increasing attention since the term was coined by Freudenberger in 1974.(1) It is amazing that the first systematic description of occupational physical or mental burnout was provided more than two centuries after the modern contextualization of work.(2) It is even more astonishing that more than 40 years have passed without any studies assessing the actual implications of burnout syndrome on the work dynamics in healthcare and the outcomes on patient care. Despite a significant increase in the number of studies on this subject that have been published in the last five years (Figure 1), the number is still very small compared to studies of other occupational diseases (not exceeding approximately 70 articles on the topic per year). In this edition of the Revista Brasileira de Terapia Intensiva, Tironi et al.(3) report the results of a systematic questionnaire completed by 180 Brazilian intensive care physicians from five state capitals. The prevalence of symptoms of emotional burnout, depersonalization, and inefficiency was evaluated using the abovementioned previously validated systematic questionnaire. The authors were careful to make their sample representative of the overall population by including 60 intensive care units in large Brazilian capitals; however, the return rate of the questionnaires was considerably lower than expected (despite the abovementioned refusal to participate by some centers). Thus, before interpreting the study results, we must emphasize that they refer to professionals willing to complete the questionnaire in units that agreed to participate in the study. Thus, it is possible that a larger sample would lead to even more alarming results. The authors found a burnout prevalence of greater than 60%, when considering burnout as the presence of at least one of the domains involved. The results of Tironi(3) must be interpreted in conjunction with the results of other international initiatives and with the data on professional and personal satisfaction among intensivists published by Nassar, also in Revista Brasileira de Terapia Intensiva.(4) The Brazilian intensivist is young, often well paid, but subject to a high weekly workload. As with other doctors in other parts of the world, emotional exhaustion is the most frequently reported component of burnout syndrome.(5) However, Brazilian intensivists seem to suffer from burnout more frequently than their Portuguese colleagues.(6) We know little about the consequences of burnout. The direct relationship between burnout and worse care performance, although plausible, has yet to be demonstrated in practice. Some data suggest that patient satisfaction is lower when the assistant physician suffers from burnout; however, the link between the presence of the syndrome and worse outcomes still needs to be clearly demonstrated.(7) There is, however, indirect evidence. Emergency physicians Fernando Godinho Zampieri1,2