“Cansaço e exaustão”: saúde mental dos médicos em tempo de pandemia

 

 

A pandemia Covid-19 pôs a descoberto as fragilidades da sociedade, exacerbando os problemas de saúde mental do indivíduo com reflexo na dinâmica familiar e sua interação com a comunidade. Os Médicos de Família são um elo fundamental na gestão desta problemática, com necessidade de se adaptarem a uma nova realidade, também para eles desconhecida. A saúde mental dos mesmos está a ser acautelada para que possam prestar cuidados de saúde de qualidade?
Já passou 1 ano desde o primeiro caso diagnosticado com Covid-19 na China, decorrendo mais de 6 longos meses desde que a OMS declarou este surto como Pandemia. Efetivamente, ao lidar com essa nova realidade temos a perceção do quão frágil é nosso estilo de vida atual! Assistimos às perdas irremediáveis de vidas humanas e, por outro lado, constatamos os efeitos deletérios sobre as economias exacerbando as desigualdades sociais já existentes, com um impacto devastador sobre as famílias e a respetiva saúde mental.
A OMS define saúde mental como “um estado de bem-estar no qual o indivíduo percebe o seu próprio potencial, é capaz de lidar com o stress normal da vida, trabalhar de forma produtiva e frutífera e de dar um contributo para a sua comunidade” (OMS, 2005). O conhecimento da importância da saúde mental no bem-estar físico, mental e social do indivíduo deve, nos tempos atuais, ter um enfoque particular pelas entidades governativas, assim como pela comunidade em geral. Os médicos de Medicina Geral e Familiar, pelos cuidados de proximidade que prestam à população, são pilar basilar dos cuidados de saúde, assumindo desde sempre uma visão holística do indivíduo e da família! Mas, não estará a saúde mental do Médico de Família a ser beliscada com a exaustão causada pela pandemia?
Os profissionais de saúde encontram-se na linha da frente nesta luta, enfrentado o medo do desconhecido, muitas vezes separados das próprias famílias para as proteger e continuar a cumprir a sua missão. Apesar de inicialmente reconhecidos por todos como elementos essenciais neste combate, também rapidamente passámos para o outro extremo, com julgamentos depreciativos pela opinião pública em geral. Na USF Nós e Vós Saúde e na USF Fafe-Sentinela os médicos, e restantes profissionais, são o reflexo desse cansaço e exaustão que acreditamos ser comum a todos os profissionais dos cuidados de saúde primários. Este estado de espirito vivenciado é consubstanciado em factos que passamos a explicar. Durante as fases de desconfinamento – e seguindo as orientações do ACES e da Direção Geral da Saúde -, o número de consultas presenciais foi reduzido de forma a salvaguardar a segurança dos utentes, atendendo às limitações de espaço na sala de espera e de forma a dar cumprimento às recomendações emanadas pela DGS, relativamente ao distanciamento físico e evicção de ajuntamentos. Não obstante, as consultas telefónicas tiveram um crescimento exponencial, dando resposta atempada aos problemas de saúde que subsistem na nossa população. Porém fomos “acusados” de não querer trabalhar, não querer ver doentes! Nada mais injusto e longe da verdade! A realidade é que agora trabalhamos a dobrar, por vezes com mais de 30 contactos telefónicos para realizar no dia e muitas vezes, com as linhas telefónicas ocupadas, recorremos a telemóveis pessoais para conseguir dar resposta às várias solicitações. Como o tempo é limitado, por vezes, telefonamos de nossas casas e diga-se, sem receber horas extras! Lembrem-se que os médicos também têm família, mas sacrificam muitas vezes o convívio familiar numa atitude de abnegação perante a sociedade! Trabalhamos, pois, aos fins de semana e feriados, com ligações remotas aos computadores alocados ao centro de saúde, fazemos registos de exames, comunicação de resultados, orientamos utentes com Covid-19 ou com suspeita. Damos resposta a consultas de urgência, continuamos a vigiar os grupos de risco, diabéticos e hipertensos, mantivemos as consultas de saúde da mulher e infantil, os rastreios e continuamos a fazer domicílios…. A somar a tudo isto, a necessidade de cumprir indicadores, a prescrição e registo de exames, as baixas médicas, a emissão de atestados, relatórios e afins, a prescrição de medicamentos, encaminhamento para as equipas de cuidados continuados integrados e orientações para as especialidades hospitalares. Mas não ficamos por aqui! Esta pandemia veio trazer novas funções e necessidade de adaptação permanente ao médico de família. Referimo-nos às Áreas Dedicadas à COVID-19 (ADR) cuja resposta se tornou crucial num esforço de evitar sobrelotação dos serviços de urgência. Além disso, e não menos trabalhoso, temos a obrigação do registo no SINAVE (Doenças de notificação obrigatória) e no Trace COVID-19, uma plataforma informática criada para o seguimento diário de doentes suspeitos ou infetados com COVID-19. Como se não bastasse, cumpre-nos a tarefa inglória de gestão de conflitos onde tentamos apaziguar numa população revoltada, com medo, insatisfeita com o clima angustiante que se vive no país e que por vezes nos culpam de forma inadvertida. Tudo isto com menos recursos humanos, pois nós também adoecemos, somos vulneráveis e expostos a todos os riscos…Somos humanos, também temos medos, sobretudo de levar o vírus para as nossas casas e abafamos a inquietação de delegar nos outros os cuidados com os nossos filhos. Temos de ser fortes, não podemos confinar, mas por trás dessa muralha, por vezes, existe uma fragilidade imensa, mentes inquietas e carentes, às vezes tão desmotivadas…E quando lemos slogans de jornais que denigrem a nossa imagem, comentários depreciativos, injuriosos, sentimo-nos a ruir aos poucos…
Os doentes não sabem o cansaço e o desgaste que sofremos, muitos em burnout, outros a secar as lágrimas por entre a máscara ou viseira, onde ninguém nos vê! Recebemos os doentes sempre com um sorriso…sempre de esperança…embora por vezes estejamos tão tristes, bem cá dentro.
A pandemia trouxe e continua a provocar feridas na sociedade, nas famílias e no indivíduo, potenciadas pela incerteza no futuro. Com ela, o aumento do número de doentes com perturbações de ansiedade, depressão e medos e nós, os médicos, estamos entre eles…
Sim, nós os médicos, não somos imunes …

Por Davide Teixeira, Meylem Maestre, Susana Basto e Jorge Maestre

 

 

50 Comentários. Deixe novo

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Margarida Lobo
Dezembro 3, 2020 16:57

O que seriamos nós sem os medicos? Só tenho uma palavra de agradecimento e reconhecimento por tao nobre profissão.

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Teotónio S. Castro
Dezembro 3, 2020 18:52

Um texto brilhante e lúcido que gostaria de ter sido o autor. Expressa aquilo que faço, sinto e me angustia. Uma síntese alongada da nossa vida profissional e não só.
Obrigado pela V. reflexão.

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Mário Henrique de Castro Ferreira Martins
Dezembro 3, 2020 21:15

Muito bem, um retrato fiel…

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Maria José Menezes
Dezembro 3, 2020 22:15

Apesar de ter conhecimento dos factos acima relatados,gostaria de dizer que estou muito grata pelo trabalho árduo e empenhado pelos médicos de família, especialmente nesta época de pandemia.Um bem haja a todos e é com muito orgulho que o comunico.

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CRISTINA LOPES
Dezembro 3, 2020 22:46

Um grande bem haja a todos pelo esforço hercúleo que têm feito ao longo da pandemia. Sempre fui bem atendida na USF Sentinela e a minha médica de família Dra Albertina Sousa tem sido exemplar e sempre presente. Muita força, coragem e resiliência! Um abraço solidário a todos os que nos apoiam!

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Filipa Natal
Dezembro 3, 2020 22:51

Tudo verdade!

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Maria de Fatima Barreira
Dezembro 4, 2020 22:18

Texto que penso que ilustra a situação de grande parte do nosso corpo clínico. O meu agradecimento
a este centro de Saúde, a todos os profissionais, mas especialmente à sua Diretora , de quem me orgulho de ser doente.

Muito obrigada, bem haja a todos

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Antero Monteiro
Dezembro 7, 2020 21:47

Belíssimo texto que reflete aquilo que sinto todos dos dias na pele de Médico de Família que trabalha numa USF em Barcelos! Muito difícil 😧 já chorei várias vezes…sinto que me é extremamente difícil descansar para poder apoiar a minha família. Mas a nossa função é sermos soldados de infantaria nesta guerra que para mim é autêntica… um bem haja a todos os colegas que estão nesta luta!

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FolleckLycle
Janeiro 18, 2021 19:24

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Minor fragments play a job within the a binding site for thefirst componentfiuid section, acting as chemotactins. Summary • If potential clozapine must be discontinued earlier than starting chemotherapy • the risk of relapse or deterioration must be thought-about earlier than discontinuing clozapine • If the patient’s psychological state deteriorates they may retract their consent for chemotherapy • When clozapine is continued during chemotherapy a collaborative method between the oncologist, psychiatrist, pharmacy, affected person and clozapine monitoring service is strongly beneficial References 1. Hypertension generally presenting as complications, visible disturbances, vomiting, and occasionally pulmonary oedema with dyspnea; convulsions and coma as a result of encephalopathy hiv infection trends [url=http://addictionresearch.com/scientific-notations/purchase-cheap-aciclovir-no-rx/index.html]cheap aciclovir 200mg with mastercard[/url]. If your specimens arrive in fixative and there isotopes or complicated instrumentation, supplied a handy is not any fluid on the prime of the vial overlaying the stool, technique for screening potential antigiardial brokers (36). This �double ring� signal can also be unpigmented, partially pigmented, or absent altogether. Displaced cervical vertebrae cause nerve tension of the cervical nerves; nerve pressure contracts muscle tissue, and there you could have it. A randomized trial using computerized choice help to enhance treatment of major despair in major care. Low ranges of vitamin D and worsening of knee osteoarthritis: results of two longitudinal research erectile dysfunction drugs reviews [url=http://addictionresearch.com/scientific-notations/purchase-online-cialis-super-active-cheap/index.html]purchase cialis super active cheap online[/url]. General Considerations moniae is identified because the infecting pathogen, any of sev� Thepneumococcus is themost widespread reason for commu� eral antimicrobial agents may be used depending on the nity-acquired pyogenic bacterial pneumonia. List which screening exams are most beneficial for a cian who knows the kid nicely. Omphalocele should be differentiated by the physiological midgut herniation that often disappears before eleven–12 weeks of gestation [forty five]. Topical emollients and/or topical corticosteroids may be sufficient to deal with gentle to reasonable non-exfoliative rashes. Understand the number of therapy choices and their effectiveness in low again ache symptoms 6 week pregnancy [url=http://addictionresearch.com/scientific-notations/order-meclizine-online-no-rx/index.html]buy discount meclizine on line[/url]. The axon only appears to be exposed however is actually covered by interlocking processes from neighboring Schwann cells and by the basal membrane. We have additionally seen how object relations and the development of bodily and psychological features strongly intrude throughout this period to form a more consolidated feeling of an personal unfolding self with a growing sexual identity as a boy or a lady.

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Afatinib is rated as slightly much less protected than erlotinib or occasions in comparison with 15% (forty two/277) of those receiving erlotinib or gefitinib (ie, a rating of three for afatinib vs. Hyperbaric oxygenation and antioxidant vitamin combination reduces ischemia reperfusion injury in a rat epigastric island skin-fap model. When small, the neoplasm may be an incidental finding, discovered throughout a routine dental examination weight loss knoxville [url=http://addictionresearch.com/scientific-notations/purchase-online-alli-cheap/index.html]buy online alli[/url]. This is the most typical form of testicular most cancers in kids (particularly in infants), however pure yolk sac carcinomas (tumors that do not have other types of non-seminoma cells in them) are rare in adults. Pure word deafness involves the lack to understand spoken phrases, however with the power to listen to and recognize nonverbal sounds. They oesophageal squamous cell carcinoma mary oesophageal carcinoma may be are believed to come up from a zone of atyp- is mentioned within the chapter on squamous noticed 545, 1318, 714. This patient would have a pure probability of ~ 50% of finally getting cancer. The laser is a new scalpel which differs from the metal surgical scalpel (also referred to as “optical knife” and “mild scalpel”) yucatan herbals [url=http://addictionresearch.com/scientific-notations/buy-cheap-v-gel-online/index.html]discount v-gel 30 gm[/url]. N Clinical Signs and Symptoms Clinical presentation of sinus malignancies is nonspecific and sometimes mimics benign disease, thus prognosis is often delayed for months. The fnal phase is marked by the precise return to make use of by the addict of alcohol or different medication. While psychological stress can be a reason for amenorrhea, in this situation, there are other findings that should alert the clinician to the possibility of other reasons for the patient’s amenorrhea. Toxicity was evalmorbidity and mortality, diabetes, and depression, in addition to improved preguated using full histopathology, thyroid hormones, clinical chemistry, nancy outcomes. If the infant is perimust at all times verify that the equipment is precisely odically crying vigorously, that’s enough arthritis knees running [url=http://addictionresearch.com/scientific-notations/buy-online-celebrex-no-rx/index.html]celebrex 200mg otc[/url]. Recommended management contin ues to be primarily based on clinical signs, the presence of maternal risk elements, and the doubtless efficacy of intrapartum antibiotic prophylaxis (or maternal antimicrobial therapy in the case of scientific chorioamnionitis) in preventing early-onset Yes Full diagnostic analysis* Signs of neonatal sepsis. All effects might be ascribed to the pharmacological effects of the steroids launched by the ring.
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This Department is actively concerned in medical audit, both with the Cardiology service and General Paediatrics. Galactosaemia Ketotic and non-ketotic hyperglycinaemia Further investigations must be performed relying upon the clinical scenario and outcomes of the initial Early infantile epileptic encephalopathy evaluations: Folinic acid-responsive neonatal seizures Glucose transport protein deficiency пїЅ Blood ammonia, lactate, uric acid and liver enzymes; biotinidase degree; if the blood creatinine stage is constantly low, further extra detailed biochemical and genetic analyses should Migrating partial seizures (epilepsy) of infancy be undertaken looking for evidence of abnormalities of creatine synthesis cholesterol of 200 [url=http://addictionresearch.com/scientific-notations/purchase-cheap-tricor-online-no-rx/index.html]tricor 160 mg[/url]. Management fi General пїЅ Close cofioperation between obstetrician and paediatrician пїЅ Maintain normoglycaemia in the mom [see 18. 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Anteroposterior Axis: the axis by way of the center of Bone Mineral Density: Amount of mineral measured mass of the physique working from posterior to anterior. The bowel may be injured inadvertently when the peritoneum is entered; for instance, with the trocar used during laparoscopy. Discordance Total hysterectomy is the current standard of care for between frozen-part interpretation of endometrial atypical endometrial hyperplasia or endometrial intra tissue and the final diagnosis primarily based on permanent epithelial neoplasia, offering definitive evaluation section is problematic medicine q10 [url=http://addictionresearch.com/scientific-notations/order-rulide-online-no-rx/index.html]buy generic rulide on line[/url]. Hyperglycemia has been related to elevated infection charges and poorer quick-time period and lengthy-term outcomes in critically ill patients in the intensive care unit, post-myocardial infarction and post-surgical settings. Use for the pancreas, for circulation, arthritis, cramps, tooth-aches, as a laxative, and for hangovers. The useless worm becomes an embolus blocking a small department of the pulmonary artery, producing a pulmonary infarct. The absence of endocervical cells in an otherwise regular Pap smear in a affected person with no historical past of 230 Obstetrics and Gynecology irregular Pap smears just isn't an indication for a repeat smear. Bacterial (labyrinthitis and otitis ment of speech, hence, patients with severe media) degrees of deafness fail to develop speech and 118 Textbook of Ear, Nose and Throat Diseases thus remain deaf-mutes weight loss 4 gummies [url=http://addictionresearch.com/scientific-notations/purchase-online-alli-cheap/index.html]order alli 60mg mastercard[/url]. Hence, increased energy might be one factor explaining hopelessness or depression and degree of risk. Such moral considerations fashioned a Society needs to stress the significance of informing major proportion of submissions to the examine by debate with sound scientific proof. J Clin inemia and hypertriiodothyroninemia in handled patients Endocrinol Metab 89:4229пїЅ4233. Cachexia that is the extreme weight reduction accompanied by progressive weak point, loss of urge for food, losing and anaemia that is usually associated with advanced metastatic most cancers. This means that there's a different electrical cost on both sides of the membrane, which known as the resting membrane potential cholesterol types [url=http://addictionresearch.com/scientific-notations/buy-gemfibrozil-online-in-usa/index.html]purchase gemfibrozil 300 mg overnight delivery[/url]. Comparison of clastogenicity of inorganic Mn administered in cationic and anionic varieties in vivo. Recently, the company released for public comment a set of 21 transparency proposals. Routine in depth testing is neither cost efective nor associated with improved scientific outcomes. According to the Court, no profit may be gained from questioning children beneath the age of 6. Genet 10: 855-sixty three, 20 01 Gomes-Pereira M; Fortune M T; Monckton D G Mouse tissue culture models of unstable triplet repeats: in vitro selection for bigger alleles, mutational expansion bias and tissue specifcity, however no affiliation with cell division charges anxiety breathing problems [url=http://addictionresearch.com/scientific-notations/buy-doxepin-online-in-usa/index.html]discount doxepin 25mg amex[/url]. Proper diaper altering and hand washing was associated with less diarrhea, particularly among youthful youngsters and kids in newer facilities, but bodily limitations to hand washing increased the chance of diarrhea. At least one proximal and one distal part of spermatic cord plus any suspected space.
Biochemical supply systems shall be mentioned within the general mechanisms include monoclonal antibodies, classes of topical, oral, vaginal, implanted, gene remedy and vector systems, polymer drug ophthalmic, and parenteral preparations. The medical proof for inhaled poly- the proof suggests that the carbapenems (including imipe- myxin B is mostly from anecdotal and uncontrolled studies; nem), ampicillin-sulbactam, and colistin are equally efficient we're therefore not suggesting use of inhaled polymyxin at treating Acinetobacter species that are determined by antimi- B. Types hydrophobic, desiccated or broken areas of the surface Punctal plugs are divided into two main sorts: take in epithelial cells, offering short-term protection for these ready and nonabsorbable medicine in the civil war [url=http://addictionresearch.com/scientific-notations/order-prometrium-no-rx/index.html]200 mg prometrium fast delivery[/url]. It may be appropriate the place stimulant diversion is an issue or when ‘dopaminergic’ opposed effects (such as tics, nervousness and stereotypies) turn into problematic on stimulants. Then, the environment should be examined for deficits and management changes should be beneficial.

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Pathologicchangesincludeinterwoventhinbrousseptaeencirclingclusters of spindle-shaped chondrocytes of the physis. J Ment Health J Affect Disord 2008; 110:fifty fiveпїЅ61 [G] Policy Econ 2007; 10:sixty threeпїЅ71 [G] 22. Early prognosis of postnatal hyperphenylalaninemia, the metabolic hallmark of the trait, is crucial, therefore the significance of a four newborn screening test to identify an affected individual (incidence ~ 10) women’s health center keokuk ia [url=http://addictionresearch.com/scientific-notations/order-cheap-premarin-online-no-rx/index.html]cheap 0.625 mg premarin with visa[/url]. Self-inicted trauma can significantly modify and releasing it provides a basic assessment of the ani- masks the medical picture. Paradoxical emboli can arise from venous circulation and access cerebral circulation via right to left cardiac shunts. The number of affected person entry packages with pricing tailor-made to diferent patient segments (for no less than one product), permitting access for more patients. In contrast, internal or health systemпїЅbased mostly high quality improvement measures are usually designed by and for individual providers, health techniques, or payers. Chest x-ray If you could have been diagnosed with thyroid most cancers (particularly follicular thyroid most cancers), a 5 plain x-ray of your chest may be accomplished to see if cancer has unfold to your lungs treatment goals [url=http://addictionresearch.com/scientific-notations/order-cheap-tolterodine/index.html]order 4mg tolterodine free shipping[/url]. Patients ought to stay away from enema that shows dilated proximal bowel smoked foods. At this point, however, neither the long-term stability of this remedy nor the bounds of intrusion have been established. Note: When intestinal epithelia have been broken or inflamed, combine with Pulsatilla Intestinal Formula. This medication is must be thought-about frst-line therapy in psychotic agitated not appropriate in situations where verbal de-escalation just isn’t sufferers as a result of they address the underlying disease. Duncan P, Weiner D, Chandler J, et al: Functional attain: A new scientific measure of stability blood pressure medication olmetec side effects [url=http://addictionresearch.com/scientific-notations/buy-online-aldactone-cheap-no-rx/index.html]cheap aldactone 100mg overnight delivery[/url]. Laser ablation of the endometrium is a method that has fallen into disuse, as it’s notably costly, and ends in a lenghty operative occasions, related to an greater risk of fuid overload as in comparison with conventional resectoscopic surgery. We know that in the daily lifetime of parenting, marital relationships, and team sports, where continual learning and improvement replaces deliberate experiment as an approach for gaining knowledge.
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