What happens to health professionals when the ill patient is the health care system? Understanding the experience of practising medicine in the Romanian socio-cultural context

摘要

Our aims were to investigate the sources of work strain and stress, and the way in which they are experienced by Romanian health professionals in a work context shaped by the ongoing 20 years long reform of the national health care system. Design An exploratory, qualitative design was used to investigate medical professionals' perceptions of stress and work strain. Methods Twenty eight interviews and two focus groups were conducted with 38 physicians, residents and nurses, between the age of 26 and 53. A semi-structured interview guide was used for data gathering and the major themes were identified using thematic analysis of the transcripts. Results Three themes emerged in the analysis: governance and health system management, scarcity of resources, and health system reputation. Health professionals described the image of a suffering health system, exhausted by an inconsistent management plan, underfunded and understaffed; a system that is a constant source of discontent, bitterness and doubts for them and their patients. Conclusions Romanian health professionals' experiences reveal a health care system which after 20 years of reform managed to shape a learned helplessness culture within the medical community and drive a large proportion of its workforce across the borders. Statement of contribution What is already known on this subject? Cultural, political, and socio-economic factors influence the work context and shape the employees' working experience. What does this study add? We describe Romanian health professionals' (HPs) relationship with the national health system, the work environment it creates, and its impact on the quality of their work experience. We draw on HPs' experience to understand how the socio-economic and political context shapes a culture of learned helplessness and blame against the health system, within the medical community, and the exodus of Romanian HPs searching for working opportunities abroad.