Caring for Caregivers

Generalities. They say there are three impossible tasks. Govern, educate and heal. Try to substantiate it is said that healing is one of the three impossible tasks.

-Patient care requires doctors us giving up multiple satisfactions of our desires, and transform these desires into a thinking and a doing in line with professional requirements.

The team of health care need to make the effort to isolate permanently and decide between pleasure and intellectual activity for which it is convened.

Among the taboos and working spaces. Between pleasure and rationality.

Between satisfying the desires filicidal, fratricide, parricide and incestuous and transform these into a thought. Who has not suffered or hated, in a professional capacity?, Like your little patients could be our child if we pediatricians, the old man our father if we gerontologists. Patients should, or rather should I say? - Give up our desires for the sake of the common task is to restore health.

To suppress these desires as patients are assigned to the same doctors. The health team, believes the patient, can do everything, everything you do, (like a child thinks about adults, and that's the position we will find yourself when sick, helplessness and dependency).

To him is attributed the possibility of pleasure and satisfaction of unlimited power. When we are sick do not envy the healthy?, Though sometimes from a position idealize neurotic illness as contextual demands refuge. But doctors are limited by the rules and contextual own superego.

So were placed in a paradoxical position, alleged possibility of complete satisfaction and rules that prevent it.

They are paralyzing mandates that emerge with projects involving work on the task sublimations.

Everyday we are exposed to several cases of varying complexity in the relationship with patients. In addition, society expects of us fitness, honesty, dedication, we have no prejudices, we are sympathetic, blameless private life, tolerance for pain, firmness and tenderness, plastic to adapt to multiple situations, self-denial, control and management of emotions , getting along with colleagues, produce scientifically guards outside health, poor and strong, do not fail because it depends on the health or life of another, separate the personal from the professional ,........ and listing requirements could continue.

There are also singularities associated with each medical specialty.

The anguish of the doctor or specialist in intensive care, the surgeon or who attends to emergencies. Those who have contact with patients or infectious serious or terminal, may be exposed to psychic demonstrations that are expressed through symptoms that then enumerate.

To this add:

* The impoverishment of professional practice.

The attending physician is forced to reduce their quality of life and the exercise by the medicine has ceased to be the doctor-patient binomial forming an indivisible contract with a moral and reasonable compensation background material, transformed by the work of institutions such as Social Work , Insurance, Prepaid, in a trio with severe consequences on health care and the doctor.

The decrease in pay requires the extension and acceleration of business hours, hasty examination which degrades the efficiency and distorts the material and moral covenant medical consultation.

* The mechanism. The glare produced by the apparatus leads to a super-medicine with despari-tion or reduction of concern for the sick man.

This loss is felt as a lack of the patient seeking restitution in exotic religions or al-alternatives therapies.

They have a boomerang effect on us doctors.

Is it easy to mentally process for us, health professionals, the competition "successful" procedures without much scientific basis against a rigorous training demanded prolonged efforts we?

* The objectification. Currently phenomenological approach tends to laboratory analysis, instrumental studies, and radiological agents. We live in the most cases in a society where medical practice is favored by the depersonalized care, dominated the performance of multidisciplinary and interdisciplinary, with loss of GP, with mass distribution of medical issues faced with neglect, with reckless use of new techniques without casuistry with sufficient scientific backing. With "industries of the trial" that lead to the avoidance of defensive medical procedures while useful may involve risk. Either positive defense mechanisms such as excessive procedures and services to defend against malpractice.

* The Market. The concentration of economic power in few hands and the need for modern science to be assisted by the same ethical problems unpublished.

* Last but not least the patient. The health team offers something that marketers call "negative demand product," nobody likes to see a doctor.

Here are some reasons why healing is an impossible task.

Symptomatic Reperecusiones more common in the health care team. In clinical practice with physician groups with which we carry out tasks of reflection on the pathology triggered by the occupation, we find ourselves with a series of events that, although dependent on individual psychic constellations, have a common factor.

The trigger is located in relation to some specialties and in the present case, in particular those related to the care of terminally ill patients.

In this set of symptoms may include: cathartic discharges, screaming, colic, ulcers, constipation, somatic symptoms associated with anxiety such as tachycardia, pallor, hot flashes, shortness of breath, dyspepsia, eructation, nausea, vomiting, urinary frequency, headache , dry mouth, sweating, shaking and tingling, dermatitis, pruritus, rash, herpes simplex, allergic and asthmatic reactions repeated accidents, automatic anxiety, insomnia, headaches, irritability, depression, fits of anger, hypertension, active passive transformation, and increasing degree of severity injuries such as ulcers, heart attacks and strokes, as overt manifestations.

What to say about the movement to other areas of privacy of a doctor.

Distancing or conflicts with family and friends, abandonment of children, marital arguments, alienation at work, or reactively, a depersonalization with emotional detachment.

Certainly the shell to the affects or useful transient dissociation is necessary for the effective exercise of medical activities. But only if it is useful and transient.

In contrast, the chronicity of such mechanisms for the team carries a cost mental health, the automation of our human condition.

In this line physicians increasingly feel isolated fragments (livers, lungs, stomachs, and also in increasing degrees of depersonalization, to beds, numbers of patients, "Billings", "clinical cases" retributive capacity fees), name a few indicators of dehumanization and estrangement.

For a person with advanced somatic disease, admitted to a hospital or sanatorium that is alien to him, the prognosis of certain death may even predate the arrival of the doctor.

If you are not lucky enough to be considered a "medical case" which, for scientific interest, attention devoted to it, death is likely to integrate a chain of production.

It is usually in the hospital where it develops a complex collusion among staff caring for the patient with irreversible disease.

Clearly it acts as if the dying should live, but unconsciously staff respond less quickly to calls.

Currently, a patient dies in hospital, surrounded not so much of loved ones, but a team of specialists in "die."

In traditional societies where it maintains the interpersonal relationship between doctor and patient, and there is still a doctor, the patient is treated as a person dying.

Patients dying is helpful, special assignments until the last moment, they remain embedded in the family. The doctor goes to his patient in the last resort. Death is the crown of a person's life.

In modern societies, where medical practice is favored by the depersonalized care, dominated the performance of multidisciplinary and interdisciplinary rivers, with loss of the physician, patients in these cases are expensive, they are useless and even socially upset by dependence. Remain rejected in the health service or alone at home. Die alone or in the hospital. The person is reduced to a low number given. Death is meaningless. No impact to the family or the physician. Is experienced as liberation.

Caring for the caregivers.

This is not the space to justify psychopathologically like symptoms are generated, the experience shows that it is not enough to chat with a colleague and share our professional anxieties.

No doubt that is very valuable, but the nature of matter that is addressed, requires a framework and listens more epecializada.

The mere evacuation, which is not transformed into a thought, at best produce temporary relief that does not protect from future excesses, and symptoms of flooding. Both downloading and who you listen to us, and the continuation of the chain in other colleagues.

It is ironic that we see that we care, we are not careful. You have full effect that "in house knife smith stick."

Doctors from the patient with terminal somatic disease. The doctors we are in our work, from the obligation to process the requirements described above.

In the singular case in point, terminal patients, unknowable process what improcesable by the confrontation with death.

The patient is terminal which inevitably claim that we become all terminally ill patients, and always threatening to come from the exterior.

In truth is with us from birth. The core thanatic lethal, lives with us, just wait silent and active.

At any time, any one of us becomes terminally ill.

Listening to the patient, shows that the discourse of these, boasts a brand that is beyond subjectivism listening doctor.

Commonly used expressions such as "had a monotone voice, or wheezing, or rustling sounds, or made me drowsy, I left confused, his speech left me dizzy overflowing, I understood nothing of what he said," are expressions that we say is not safe. Nor is it safe so we do not say clearly, but through silence, sign language, family, or the surrounding context.

The speech, sometimes communication loses its value and becomes the means to do. In a cathartic act that can have greater or lesser effect on the partner inoculatorio. Act to which the physician is exposed. And what's worse, many do not know or refuses.

Intellectual knowledge has stripped of its significance as it would otherwise not be exposed so as omnipotent, and exposing their patients.

The development of the metapsychology of these problems that fall outside of the nature of this meeting.

But we need to lay down two things:

First In the case of terminally ill patients should be taken into account, that he who comes to share and hear each other in their final days, he should prepare to receive the echoes of its Death

Second. Doing psychotherapy is very serious and exercise is something that requires responsibility and training. Perhaps the anxiety, the audacity or ignorance, perhaps the furor curandis which is the worst enemy the chance to help, perhaps because it is filtered once at the bottom that they "anyway is going to die" is that filters the operational mode that has serious ethical implications.

Doctors and health team in general, facing terminal patients, if they have the necessary training, and support psychological defenses sufficient to process the emotions that you wake up, pay by way of psychological symptoms with a cost greater than habitual.

Symptoms that are positive when you have noisy demonstration, because alert and allow prevention. Vital implications.

More worrying are the senses and affections somatic injury by sudden irruption, involving claudication.

In my view we need to make them aware of these risks and protect ourselves. Perhaps above all of it ourselves.

Many colleagues say that they see nothing of this.

It is logical. They have the instrument. It's like trying to see microbes without a microscope.

Without our very own, is exposed to radiation without lead apron.

It is invisible but it works. Like many things essential is invisible to the eye. It llamtivo that while some much need, yet it is so rejected. Often care services Palliative Medicine, are languishing and staff to give up the task to migrate to other services, to escape the conflict through transgression of the medical act, desafectivización, demonstration intervinculares intrasomática or alterations.

And I think it's because they lack awareness and understanding theory to understand and pressing demands recklessness and excess.

The health team is invaded by the action Thanatos, own and that provided by the terminally ill.

Not being neutralized through the sublimation, creativity, work projects that promote fraternal ties, become a regression.

The destructive impulse is not exhausted, it becomes a disguised self-harm in a thousand ways, with the disintegration of the working groups first, and conditions of its members picosomáticas later.

Experiences, suggestions and reflections.

Monitoring a palliative care team, conducting focus groups about the task, let me make some observations which I encourage to stimulate the topic, trying to get out of the empirical and intuitive activity to address our theoretical conceptualization.

Certainly the majority of palliative medicine deals with cancer patients, but also cardiac patients are terminal, or kidney or lung to name a few.

In fact we are all terminal.

But she said the experience allowed us to observe that doctors, nurses, physiotherapists, worked with less distress, discrimination contraidentificaciones nándose of the patients, with improved efficiency and processing the emotional toll that these deposits on the staff. The patients had shorter hospital stay, marking a difference between patients who had therapeutic assistance and those not.

This is important not only from an ethical perspective, insofar as it involves a reintegration of the patient to his beloved family setting, but also from the viewpoint of hospital management.

Economic benefit to the institution.

Emotional differences were observed quantitative and qualitative staff going between the study group assistance and those not.

Benefited professionals and patients.

But despite the obvious advantages, the fear of change and above all the prejudice to a different task constantly conspire so that it becomes widespread.

The emotions that are unleashed on the staff of the health team for these tasks are not safe.

Can act via neuroendocrine traumatically, lowering the immune system, offering the body. It is widely coniocida the fall of T lymphocytes by stress.La accióon the ability to think often clouded by removal of the memory traces of the soul through flood unbound amount of energy and manifest as automatic anxiety.

The inability to perform specific actions consistent with the purposes required by the patient and the context, generates far from caring and care to continue in operational conditions our profession, act in a self-and hetero-iatrogenic abodajes proposing inadequate, if not perverse .

It generates a particular way of seudorrelación the physician and the patient, which is the antithesis of love, understood as including the like.

In the current work professionally and ignore are largely ignored, marginalized and outcast, exile and exiles. We are strangers and "give back". We are on the verge of intellectual genocide by omission.

This is the field in which many times, and almost naively physicians we face, and fled.

Fleeing the evitmos.

By avoiding not appreciated.

But no longer exists.