Have you ever thought that you are no longer fit to be a physician?

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Although we have no doubt that we should be the linchpin for managing the current problems that healthcare systems face (chronicity, frailty, limited resources, equity), the day-to-day of an internist is tough. We all know what it is to work on an inpatient ward in the winter months, or to manage the holidays without being able to reduce our patient care activity because we are dependent on Emergency Department consultation rates, or to care for complex patients of all ages who have passed through multiple specialists who have not solved their problem. In most cases, we do not solve it either, but our idiosyncrasy allows us to live with uncertainty, even though we can only partially alleviate the symptoms of a disease or, in rare cases, cure it definitively.The frustration that arises from these circumstances begins to contaminate our routine clinical practice, leading to a pessimistic and skeptical response in the exercise of our profession that can progress to a feeling of professional failure, loss of self-esteem, and depersonalization.<a class="elsevierStyleCrossRef" href="#bib0055">1</a>Among healthcare professionals, like in other professions that work with people, the onset of burnout syndrome is common. Although its exact prevalence is not known, some assert that it affects more than half of professionals in the medical field.<a class="elsevierStyleCrossRef" href="#bib0060">2</a> This uncertainty is in part due to the fact that there is no single definition of the problem and that it is unknown what the most relevant symptoms are, how to diagnose it, and what its treatment should be.<a class="elsevierStyleCrossRef" href="#bib0065">3</a>The Maslach Burnout Inventory (MBI) survey is the most commonly used instrument for detecting this syndrome. Some find that it is more effective to investigate a few sections of the survey rather than complete it in its entirety, especially if the investigation is focused on the domains of emotional exhaustion, depersonalization, and personal accomplishment.<a class="elsevierStyleCrossRef" href="#bib0065">3</a> Nevertheless, there is no consensus on the utility of the MBI among healthcare professionals.The consequences of burnout syndrome are severe and cause problems among all actors involved in healthcare. In regard to physicians themselves, the use of illicit drugs, depression, suicidal tendencies, and even traffic accidents increase.<a class="elsevierStyleCrossRefs" href="#bib0070">4–6</a> Although it can manifest in the form of organic diseases and psychiatric disorders, it has not been determined at what point in time the risk of onset of these complications in professionals increases nor what other factors may have an influence on them. In addition, the syndrome can mask a latent depressive syndrome that requires a different approach. With respect to the healthcare system itself, the productivity of physicians decreases, professional turnover increases, and, ultimately, costs increase. However, in regard to patients, there is no consensus. The majority of published works report that physician burnout decreases quality of care, increases frequency of errors, decreases patient satisfaction, and prolongs recovery times. However, a study has recently been published by members of the Stanford University School of Medicine which recognizes that burnout is indeed associated with lower-quality medical care, but also indicates that the published studies are very heterogeneous and that, as such, it would be desirable to establish what the true reality of this relationship is.<a class="elsevierStyleCrossRef" href="#bib0085">7</a>A work entitled “Burnout syndrome among internal medicine specialists: prevalence and factors associated with its onset” is published in this issue of Revista Clínica Española.<a class="elsevierStyleCrossRef" href="#bib0090">8</a> It presents the results of a survey administered to Spanish internists that investigates these aspects of physician burnout. A total of 934 physicians participated; the median age was 40 years and more than a third were younger than 35 years of age. One out of every three internists had experienced physician burnout syndrome. Job insecurity was one of the aspects that was most identified as being responsible for burnout. This fact may explain why it was more frequent among young internists.The approach to physician burnout must combine individual and organizational strategies in order to increase resilience and well-being among physicians.<a class="elsevierStyleCrossRef" href="#bib0095">9</a> Numerous measures, which have generally focused on effecting change in people, have been attempted. However, there are experiences that have demonstrated that the broader the approach, the better the results.<a class="elsevierStyleCrossRef" href="#bib0100">10</a> As the authors also indicate, the possible solutions for counteracting this syndrome include, first and foremost, recognizing the problem. For this, we must attempt to standardize the definition of the syndrome and create assessment tools that explore the origin of stress-provoking situations—whether job-related or otherwise.<a class="elsevierStyleCrossRef" href="#bib0085">7</a> Furthermore, it is necessary to restructure departments to try to improve professionals’ working conditions and, very importantly, develop training programmes for the appropriate management of stressful situations.In short, we have to rehumanize healthcare systems, but not just from the patients’ perspective.<a class="elsevierStyleCrossRef" href="#bib0095">9</a>What can we do individually to avoid the onset of burnout syndrome? We can feel fortunate to go to a job in which we can help our patients to have a better physical, mental, and social health. Easy." 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