Correspondence
COVID-19 pandemic, professionalism, and the social contract
Pandemia COVID-19, profesionalismo y contrato social
Read
564
Timeswas read the article
25
Total PDF
539
Total HTML
Share statistics
array:23 [ "pii" => "S2254887421001156" "issn" => "22548874" "doi" => "10.1016/j.rceng.2021.04.003" "estado" => "S300" "fechaPublicacion" => "2021-10-01" "aid" => "1965" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Rev Clin Esp. 2021;221:494-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0014256521001053" "issn" => "00142565" "doi" => "10.1016/j.rce.2021.04.004" "estado" => "S300" "fechaPublicacion" => "2021-10-01" "aid" => "1965" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Rev Clin Esp. 2021;221:494-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Correspondencia</span>" "titulo" => "Pandemia COVID-19, profesionalismo y contrato social" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "494" "paginaFinal" => "495" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "COVID-19 pandemic, professionalism, and the social contract" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Esquerda, J. Teres" "autores" => array:2 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Esquerda" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Teres" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2254887421001156" "doi" => "10.1016/j.rceng.2021.04.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421001156?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256521001053?idApp=WRCEE" "url" => "/00142565/0000022100000008/v1_202109280620/S0014256521001053/v1_202109280620/es/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S2254887421000904" "issn" => "22548874" "doi" => "10.1016/j.rceng.2021.05.001" "estado" => "S300" "fechaPublicacion" => "2021-10-01" "aid" => "1794" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Clin Esp. 2021;221:493" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Medicine in Images</span>" "titulo" => "Porcelain aorta" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "493" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aorta en porcelana" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1219 "Ancho" => 2167 "Tamanyo" => 120276 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Trigoso Castro, Á. Tamayo Velasco, J.P. Miramontes González" "autores" => array:3 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Trigoso Castro" ] 1 => array:2 [ "nombre" => "Á." "apellidos" => "Tamayo Velasco" ] 2 => array:2 [ "nombre" => "J.P." "apellidos" => "Miramontes González" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S001425652030028X" "doi" => "10.1016/j.rce.2019.10.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S001425652030028X?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421000904?idApp=WRCEE" "url" => "/22548874/0000022100000008/v2_202110011208/S2254887421000904/v2_202110011208/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Correspondence</span>" "titulo" => "COVID-19 pandemic, professionalism, and the social contract" "tieneTextoCompleto" => true "saludo" => "Dear Director," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "494" "paginaFinal" => "495" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Esquerda, J. Teres" "autores" => array:2 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Esquerda" "email" => array:1 [ 0 => "mesquerda@comll.cat" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Teres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Comissió de Deontologia Consell de Col.legis de Metges de Catalunya, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Institut Borja de Bioètica, Universitat Ramon Llull, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital Sant Joan de Déu Terres de Lleida, Lleida, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Comissió de Deontologia Col.legi de Metges de Barcelona, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pandemia COVID-19, profesionalismo y contrato social" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The COVID-19 pandemic has posed a massive challenge for not only the healthcare system but also for the medical profession, bringing to light the need for a long-awaited and unavoidable reform to adapt it to the 21st century.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Also imperative, however, is a more profound change in the implicit social contract between health professionals and society. That is, what patients and society expect from the medical profession, and what the latter can expect to find in society.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We come from a thousand-year-old tradition in which the implicit contract, in the words of Jovell<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>, “meant that society granted the medical profession a special status and recognition that distinguished it from other professions, and which should imply a higher salary and the power to self-regulate”.</p><p id="par0020" class="elsevierStylePara elsevierViewall">However, in these terms, it is necessary to question whether this implicit contract is still valid for our current society and, above all, whether it is useful for tackling future challenges. The professional values required, which arise from social change and the bioethical gaze, have been redefined by the social commitment, affectivity and empathy, respect for patient autonomy, commitment to public health, commitment to the environment, advances in medical science, the transfer of knowledge, skills, and attitudes, and the self-regulating nature of the profession<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The previous contract no longer matches the current context of the highly corporatized professional practice, within bureaucratized health organisations, with the centralised management, limitations to professional autonomy, demanding care pressure, disgraceful job insecurity among young people, and low salaries. All of which is associated with disproportionate expectations from society in relation to the possibilities, availability, and access to health care.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Smith<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> spoke about the “bogus contract” according to which patients and society expect doctors to provide solutions (bordering on miracles) to all kinds of problems, with low acceptance of finiteness and death, while assuming that doctors have higher status and incomes. This same author called for a new contract that addresses illness, death, and pain as part of life, in which medicine has some, yet limited powers of intervention, which accepts that doctors are not infallible and also need support, and which refrains from extravagant political promises and the demagogy of unlimited power without obligations.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The “mismatch” between the implicit contract (what society and people expect from doctors), and the explicit contract (contractual and labour conditions of professional practice) could be the reason behind the growing unhappiness, or burnout, in the medical profession which includes a large percentage of burnt out, exhausted, and unmotivated professionals<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The consequences of major burnout are significant both professionally, with poorer quality of care, more medical errors, or worse care as perceived by the patient, and personally, with lower levels of empathy, poorer quality of life, job dissatisfaction, or increased risk to mental health in general<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–7</span></a>.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ofri<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> mentioned that this unhappiness is more profound than the standard definition of burnout: “The despair I see amongst our colleagues today, however, is more than just burnout. It is a betrayal of trust, the trust we gave to our own profession”. The burnout epidemic is more related to doctors’ disappointment with the current, industrialised professional practice and the heightened demands of the system that go beyond the provision of care on its own.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In the midst of this, the COVID-19 pandemic arrived. Health professionals have responded to the increased demand in an exemplary manner, according to the outdated contract, with noble displays of altruism and generally going beyond the call of duty, including taking on the risk of infection with insufficient protection, accepting flexible scheduling, working outside their specialisations, and fulfilling uncustomary organisational and care roles.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The pandemic has clearly and obviously exposed the imbalances and asymmetry between the fulfilment of the two parts of the social contract. It has also brought to light how this discrepancy has entailed a high cost to health professionals, from the physical, psychological, or ethical perspective, which is added to the previous hardships.</p><p id="par0060" class="elsevierStylePara elsevierViewall">However, the pandemic can also represent a turning point and redefining moment for the healthcare field. Among the necessary changes to the post-pandemic practice of medicine, clear coherence between the implicit and explicit contract is essential. A new contract that is, as Jovell mentioned, “a starting point for redefining the relationship between medicine and society in the current context of social change to thereby be able to face the tension that exists between equity, good quality of care, excess care possibilities, and finite available resources”<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In creating this coherence, certain factors must address adapting contracts and salaries according to the level of responsibility, as well as aspects related to the actual practice of medicine, such as the need to recover professional autonomy, competence, and the feeling of belonging to the profession and institutions<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>, with participation in decision-making at all levels.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Lemaire and Wallace<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> identifies other key aspects such as: detecting toxic aspects in the medical profession that cause and maintain burnout, the need to promote clinical leadership and an organisational culture of support, and considering the well-being of doctors as a core part of patient care and a quality indicator for the entire health system.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Therefore, more than a patient-centred care model, perhaps we should be discussing an “aligned” model between treated individuals, health professionals, institutions, and health policies. Cohesively aligning the values, beliefs, roles, and responsibilities of the agents involved in the social contract is therefore a fundamental objective.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The medical profession in the 21st century obviously requires strengthening professional values but can only be carried out when paired with a health system that offers appropriate conditions for professional practice and a society that recognises and agrees that returning professional dignity is not the same as granting privileges.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare they do not have any conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Esquerda M, Teres J. Pandemia COVID-19, profesionalismo y contrato social. Rev Clin Esp. 2021;221:494–495.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contrato social y valores en la profesión médica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Jovell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Adm Sanit" "fecha" => "2005" "volumen" => "3" "paginaInicial" => "495" "paginaFinal" => "503" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Profesionalism. The third logic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. Freidson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2001" "editorial" => "The University of Chicago Press" "editorialLocalizacion" => "Chicago" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Why are doctors so unhappy?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Smith" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.322.7294.1074" "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "2001" "volumen" => "322" "paginaInicial" => "1074" "paginaFinal" => "1075" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11337420" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Burnout among doctors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.B. Lemaire" 1 => "J.E. Wallace" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.j3360" "Revista" => array:4 [ "tituloSerie" => "BMJ" "fecha" => "2017" "volumen" => "14" "paginaInicial" => "j3360" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Descriptive study of assotiation between quality of care and empathy and burnout in primary care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "O. Yuguero" 1 => "J.R. Marsal" 2 => "M. Buti" 3 => "M. Esquerda" 4 => "J. Soler-Gonzalez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12910-016-0160-y" "Revista" => array:6 [ "tituloSerie" => "BMC Med Ethics" "fecha" => "2017" "volumen" => "18" "paginaInicial" => "1" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28077127" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Burnout syndrome in internal medicine specialists and factors associated with its onset" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:5 [ 0 => "C. Macía-Rodríguez" 1 => "D. Martín Iglesias" 2 => "J. Moreno Diaz" 3 => "M. Aranda Sánchez" 4 => "G. Ortiz Llauradó" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2019.10.009" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2020" "volumen" => "220" "paginaInicial" => "331" "paginaFinal" => "338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31892420" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "en representación del Grupo de trabajo para deliberar sobre el síndrome de quemarse por el trabajo burnout en los médicos de España; Componentes del Grupo de trabajo para deliberar sobre el síndrome de quemarse por el trabajo burnout en los médicos de España. Work-related burnout syndrome in physicians in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Bouza" 1 => "P.R. Gil-Monte" 2 => "E. Palomo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2020" "volumen" => "220" "paginaInicial" => "359" "paginaFinal" => "363" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The covenant" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Ofri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACM.0000000000002957" "Revista" => array:6 [ "tituloSerie" => "Acad Med" "fecha" => "2019" "volumen" => "94" "paginaInicial" => "1646" "paginaFinal" => "1648" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31425190" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physician burnout, interrupted" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Hartzband" 1 => "J. Groopman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMp2003149" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2020" "volumen" => "382" "paginaInicial" => "2485" "paginaFinal" => "2487" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32356624" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000022100000008/v2_202110011208/S2254887421001156/v2_202110011208/en/main.assets" "Apartado" => array:4 [ "identificador" => "71813" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Correspondence" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022100000008/v2_202110011208/S2254887421001156/v2_202110011208/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421001156?idApp=WRCEE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 22 | 0 | 22 |
| 2024 September | 13 | 0 | 13 |
| 2024 August | 16 | 0 | 16 |
| 2024 July | 17 | 0 | 17 |
| 2024 June | 15 | 0 | 15 |
| 2024 May | 19 | 0 | 19 |
| 2024 April | 17 | 0 | 17 |
| 2024 March | 13 | 0 | 13 |
| 2024 February | 6 | 0 | 6 |
| 2024 January | 13 | 0 | 13 |
| 2023 December | 14 | 0 | 14 |
| 2023 November | 21 | 0 | 21 |
| 2023 October | 11 | 0 | 11 |
| 2023 September | 15 | 0 | 15 |
| 2023 August | 8 | 0 | 8 |
| 2023 July | 16 | 0 | 16 |
| 2023 June | 14 | 0 | 14 |
| 2023 May | 16 | 3 | 19 |
| 2023 April | 12 | 0 | 12 |
| 2023 March | 15 | 3 | 18 |
| 2023 February | 8 | 0 | 8 |
| 2023 January | 12 | 0 | 12 |
| 2022 December | 18 | 0 | 18 |
| 2022 November | 18 | 0 | 18 |
| 2022 October | 17 | 2 | 19 |
| 2022 September | 15 | 0 | 15 |
| 2022 August | 12 | 2 | 14 |
| 2022 July | 22 | 2 | 24 |
| 2022 June | 12 | 0 | 12 |
| 2022 May | 18 | 2 | 20 |
| 2022 April | 17 | 2 | 19 |
| 2022 March | 18 | 2 | 20 |
| 2022 February | 13 | 3 | 16 |
| 2022 January | 19 | 0 | 19 |
| 2021 December | 14 | 0 | 14 |
| 2021 November | 5 | 0 | 5 |
| 2021 October | 5 | 2 | 7 |
| 2021 September | 1 | 0 | 1 |
| 2021 July | 2 | 2 | 4 |
Show all
