The practice of intensive care medicine as a stress situation

Abstract

A study about the problem of stress in physician who work in intensive care units requires a previous reflection about the stress concept itself. Selye's conception undoubtedly signified a great progress for the comprehension of the processes of biological adaptation, but it seems it can not be easily applied to the psychological and social field. The decrease of psychosomatic diseases during the last world war is one of the many examples that make question the causal relationship between stress and disease. The concept of life event in anglo-saxon psychiatry is also discussed, as well as its attempt to measure the stressor character of these circumstances through a scale of points. The concept of "pathogenic situation" of German psychiatry is proposed in exchange. From this perspective, medicine in general and intensive medicine in particular can be seen as human activities constituting "pathogenic situations" for the ones who exercise them. The corresponding literature allows to establish that medicine generates more pathology in physicians than other professions, but intensive medicine does not seem to be more pathogenic than other specialties. The elements of the "medical act" which could be responsible for the stress or pathogenic situation are studied. Respecting intensive medicine, two are the characteristics which seem to contribute to make it "pathogenic" for those who exercise it: a mistaken vision of death as an "enemy" which has to be fought à outrance, and the "temporality of urgency", proper to an ICU, which makes that the doctor can not give himself time enough for listening to the patient and telling him the adequate word of consolation.