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(A) Artery of healthy model. (B) Artery with hypo-anechoic plaque (crosses) in the posterior wall of the bulb in a patient with hypercholesterolemia. <span class="elsevierStyleItalic">Abbreviations</span>: CCA, common carotid artery; ECA, external carotid artery; ICA, internal carotid artery.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L.M. Beltrán, E. Rodilla" "autores" => array:3 [ 0 => array:2 [ "nombre" => "L.M." "apellidos" => "Beltrán" ] 1 => array:2 [ "nombre" => "E." 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Bouza, P.R. Gil-Monte, E. Palomo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Bouza" "email" => array:1 [ 0 => "emilio.bouza@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "P.R." "apellidos" => "Gil-Monte" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Palomo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:2 [ "colaborador" => "on behalf of the Working Group to deliberate on burnout syndrome in doctors in Spain" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">◊</span>" "identificador" => "fn0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón; Departamento de Medicina, Universidad Complutense de Madrid (UCM); Instituto de Investigación Sanitaria Gregorio Marañón; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Investigación Psicosocial de la Conducta Organizacional (UNIPSICO), Universitat de València, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Farmacéutico, Director de la Fundación Ciencias de la Salud, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] 1 => array:2 [ "autoresLista" => "" "autores" => array:1 [ 0 => array:1 [ "colaborador" => "Components of the Working Group to deliberate on burnout syndrome in doctors in Spain" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de quemarse por el trabajo <span class="elsevierStyleItalic">(burnout)</span> en los médicos de España" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Work-related burnout syndrome is a health problem that can affect professionals of all kinds, but in particular those whose activity is related to the care of human beings. Health professionals are particularly exposed to this condition and physicians are the prototypical worker exposed to it. It is an extremely destructive health problem affecting work and personal life. It damages the quality of the work provided and adversely affects the cognitive and emotional spheres of individuals, their family life and even their physical health.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Although this syndrome was identified many years ago, the information about it is very patchy. Definitions are not precise, the process approach depends very much on the professional perspective of whoever is carrying it out and we do not, therefore, have a clean and clear picture of it.</p><p id="par0015" class="elsevierStylePara elsevierViewall">For this reason, the Ciencias de la Salud Foundation, whose objectives include preventative healthcare, has brought together professionals with knowledge of this condition from very different perspectives: Psychiatry, Psychology, Medicine, Professional Unions, Epidemiology, Law and the Organisation of Medical Colleges itself. The idea was to respond, from any of the above standpoints, to the burnout syndrome situation among Spanish physicians, putting not only the limited data available on the table, but also the opinion of the participants.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The format chosen was to prepare a series of questions about the situation, that were asked by the members of the Board of Trustees of the Foundation, to which the participants would answer with the best information available to them. It was a matter of explaining, not only what we know, but fundamentally what we do not know about burnout syndrome in Spanish physicians.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The initial meeting was held at the Royal National Academy of Medicine on 29 May 2019 and this paper aims to cover the most important points of what was discussed that day. All participants did so in a personal capacity and their views do not necessarily represent those of the associations and groupings to which they belong or which they are a part of. This document does not intend to issue guidelines or recommendations on this subject, but rather to provide an overview of the different aspects, summarise the Spanish situation and express an opinion.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">The questions about burnout syndrome were chosen by the members of the Board of Trustees of the Ciencias de la Salud Foundation with the contribution of an expert on the subject in Spain (PGM).<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1–16</span></a> They were subsequently accepted by the participants. Each one was proposed by a speaker who presented his view of the question and, after a debate, a conclusion to each question was agreed on.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The texts of the various speeches were reviewed and approved by all participants after the necessary editorial process prior to publication.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">QUESTION 1. What is the best definition of work-related burnout syndrome/burnout? Does the definition and concept of burnout syndrome require any nuance in its application to the medical profession?</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions:</span><p id="par0040" class="elsevierStylePara elsevierViewall">Burnout syndrome is “a psychological response to the chronic interpersonal and emotional work stress that appears in the professionals of service organisations who work in contact with clients or users of the organisation”. It is characterised by cognitive impairment (loss of the enthusiasm for work or low personal fulfilment in work), affective impairment (emotional and physical exhaustion), the appearance of negative attitudes and behaviours towards clients and towards the organisation and, in some cases, these symptoms are accompanied by feelings of guilt.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">QUESTION 2. What is the extent of burnout syndrome in the medical profession? Do we have global, European and Spanish data?</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions:</span><p id="par0045" class="elsevierStylePara elsevierViewall">Burnout syndrome data from around the world, referring to healthcare personnel, are obtained from studies that vary greatly in methods and time, and precise information is lacking in almost all countries. However, it may be concluded that, wherever it has been sought and with the limitations mentioned, burnout syndrome figures are very high among physicians and specialties in all places.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">QUESTION 3. Does simulation exist in this condition? Is there a fictitious and fraudulent burnout syndrome?</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions:</span><p id="par0050" class="elsevierStylePara elsevierViewall">There is no data in the literature that would allow us to state that simulation exists as a significant event in burnout syndrome.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">QUESTION 4. What are the clearest extrinsic predisposing factors? Are there intrinsic factors?</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusions:</span><p id="par0055" class="elsevierStylePara elsevierViewall">The influence of individual characteristics (intrinsic factors) is relevant and some predisposing factors can be identified, but it is the extrinsic factors, the working conditions, that are the most determinant for suffering burnout syndrome.</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">QUESTION 5. What are the most frequent initial clinical manifestations? Who alerts usually first to this diagnosis?</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusions:</span><p id="par0060" class="elsevierStylePara elsevierViewall">Healthcare professionals, who are subjected to a very high level of work stress due to the emotional, ethical and technical demands imposed by the relationship with their patients, are a professional group in which the level of suspicion about the appearance of burnout syndrome must be very high.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The initial clinical features of this syndrome are very non-specific but the appearance of symptoms related to emotional exhaustion must drive the initiation of diagnostic work in order to differentiate the syndrome from others with which it is often confused. It is not clear where and who alerts initially about the presence of burnout syndrome.</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">QUESTION 6. How is work-related burnout syndrome diagnosed?</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions:</span><p id="par0070" class="elsevierStylePara elsevierViewall">The MBI questionnaire, complemented by the CESQT questionnaire that basically introduces assessment of guilt, always in the context of a clinical interview, are the best tools available to make the diagnosis of burnout syndrome. It is essential to differentiate burnout syndrome from other disorders related to stress and depression.</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">QUESTION 7. What is the development process or phases through which burnout syndrome progresses? Can burnout syndrome be classified by severity?</span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions:</span><p id="par0075" class="elsevierStylePara elsevierViewall">Different authors have established criteria for the severity of burnout syndrome based on the presence or absence of different clinical signs. The signs or symptoms that for the different authors point to the most serious forms are: presence of clinical manifestations, mental disorders, aggressive behaviour, depressive profile and high prolactin levels. Gil-Monte proposes two profiles in which Profile 2 subjects would be the most serious and would be characterised by a greater feeling of guilt.</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">QUESTION 8. Is burnout syndrome contagious between co-workers?</span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions:</span><p id="par0080" class="elsevierStylePara elsevierViewall">There is evidence that complaints about exhaustion can be transmitted between colleagues, both consciously and unconsciously, as well as being the most important predictor of emotional exhaustion and depersonalisation at the individual and unit level. This suggests that burnout syndrome may be a contagious condition among co-workers, particularly in Intensive Care Units.</p></span></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">QUESTION 9. Which medical professionals are most affected? Are there higher-risk specialties?</span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusions:</span><p id="par0085" class="elsevierStylePara elsevierViewall">Burnout syndrome has an unequal incidence in the different medical specialties. Those at the highest risk are those with the greatest quantitative overload, such as Primary Care, due to the high care pressure, or with the greatest qualitative overload such as Intensive Care, Oncology and Geriatrics because they deal with complex, seriously ill and difficult to manage patients, or due to the difficulty to communicate and deal with the patient, such as in Mental Health.</p></span></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">QUESTION 10. Could burnout syndrome be included in the list of occupational diseases or is it a work accident?</span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusions:</span><p id="par0090" class="elsevierStylePara elsevierViewall">Burnout syndrome cannot be officially labelled as an occupational disease in Spain because it is not included in the official list of occupational diseases of RD 1299/2006. However, there is case law in Spain that recognises it as a Work Accident.</p></span></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">QUESTION 11. What is the most appropriate treatment? Is it the same for all professionals or does it have specific aspects?</span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conclusions:</span><p id="par0095" class="elsevierStylePara elsevierViewall">Multiple interventions have been studied for the management of this syndrome, but their efficacy is not sufficiently tested and, at present, there are not enough data to recommend a specific therapeutic strategy. Interventions are required in the organisation, in the professional groups and in the individual. Some are generic and valid for any professional and others are specific for certain professional groups such as primary care physicians, oncologists, intensivists or those caring for HIV patients in the early years, who have to develop and deal with the continuous contact with death.</p></span></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">QUESTION 12. Can we speak of total cure? What is the risk of relapse?</span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conclusions:</span><p id="par0100" class="elsevierStylePara elsevierViewall">We have not found clear criteria for the cure of burnout syndrome or figures that estimate the trend to recurrence after a presumed cure.</p></span></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">QUESTION 13. From the perspective of a hospital occupational health service, what is the personal cost of the burnout syndrome? Is it associated with an increased risk of suicide? What are the essential prevention measures? Who should lead and drive them?</span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Conclusions:</span><p id="par0105" class="elsevierStylePara elsevierViewall">The cost of the burnout is very high at the personal, professional and social levels. The consequences of this syndrome affect the mental health, physical health, quality of life and professional performance of the physician. The prevalence of suicidal ideation increases with the severity of the condition.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The measures to prevent burnout syndrome can be divided into three different action levels: organisational, interpersonal and individual.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Prevention must be carried out by the Occupational Risk Prevention Services in collaboration with the management of the health centre and the workers’ representatives.</p></span></span><span id="sec0145" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">QUESTION 14. Could we measure the economic-labour costs and for the society of burnout syndrome? And very particularly that of the medical profession?</span><span id="sec0150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Conclusions:</span><p id="par0120" class="elsevierStylePara elsevierViewall">Physicians with burnout syndrome have higher absenteeism rates, leave the profession early more often, and are considered less productive. Rough estimates estimate the cost of this problem to Canada's health care system at 213 million Canadian dollars. Such calculations are not available in Spain or in many other countries.</p></span></span><span id="sec0155" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">QUESTION 15. What is the view of labour lawyers about this problem?</span><span id="sec0160" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Conclusions:</span><p id="par0125" class="elsevierStylePara elsevierViewall">From the perspective of Labour Law, and based on the case law issued by the Courts and Tribunals of the Social Order, despite the existence of contradictory case law rulings, it can be concluded that burnout syndrome has been recognised as a work accident. It is very likely that the inclusion of burnout syndrome in the WHO international classification of diseases will serve for the gradual change in contingency determination and introduce a change in how the Courts have handled to date burnout syndrome.</p></span></span><span id="sec0165" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">QUESTION 16. What is the position and view of burnout syndrome on the part of the trade unions?</span><span id="sec0170" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Conclusions:</span><p id="par0130" class="elsevierStylePara elsevierViewall">The economic crisis, which began in mid-2008, has involved a remarkable increase in the physical and emotional demands on health professionals, which, together with cuts in health budgets, has aggravated the psychosocial stress to which physicians and other health professionals are subjected. The Occupational Risk Prevention services are implemented in the Health Services, but the different health institutions do not comply with the specific regulations regarding the prevention of occupational risks.</p></span></span><span id="sec0175" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0195">QUESTION 17. What knowledge does the non-specialised press have and how does it deal with the burnout syndrome problem?</span><span id="sec0180" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0200">Conclusions:</span><p id="par0135" class="elsevierStylePara elsevierViewall">The interest in burnout syndrome is shown in the records of the EFE agency where it has been present only in 0.004% of all news sent to its subscribers. Only about 10% of these are referred to physicians. Because it's a common issue, it does not become news<span class="elsevierStyleBold">.</span></p></span></span><span id="sec0185" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0205">QUESTION 18. Do we believe that there is a demand for a large national study on burnout syndrome in the medical profession? What do Medical Colleges think?</span><span id="sec0190" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0210">Conclusions:</span><p id="par0140" class="elsevierStylePara elsevierViewall">The Organisation of Medical Colleges (OMC) believes that burnout syndrome is a serious problem among physicians and that the partial data available in Spain would justify a major national study on the subject. The study should have great methodological rigour and include the adequate percentage of physicians working inside and outside the hospital environment and inside and outside the urban environment, as well as in both public and private healthcare.</p></span></span><span id="sec0195" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0215">QUESTION 19. What role do Humanities play or should play in the prevention and treatment of burnout syndrome?</span><span id="sec0200" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0220">Conclusions:</span><p id="par0145" class="elsevierStylePara elsevierViewall">There is no doubt about the need to reintroduce Humanities in the academic curriculum of medicine, and we suggest that their best knowledge could be a preventive therapeutic tool against burnout syndrome.</p></span></span><span id="sec0205" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0225">QUESTION 20. What are the ethical aspects of all this?</span><span id="sec0210" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0230">Conclusions:</span><p id="par0150" class="elsevierStylePara elsevierViewall">In the last half century the practice of the so-called liberal professions, and in particular the practice of medicine, has undergone a dramatic change. There are at least four factors in that: the passage from vertical and paternalistic interhuman relations to a horizontal one, presided over by the patients’ bills of rights; the conversion of patients from moral friends to moral strangers, and the consequent rise of defensive medicine; the emergence of a culture of efficiency in health institutions, which has forced professionals to take into account the economic factor, sometimes even to the detriment of other factors that they consider morally binding; and, finally, the revolution brought about by scientific advances, and more specifically the rise of the so-called personalised medicine or precision medicine.</p><p id="par0155" class="elsevierStylePara elsevierViewall">The conflicts generated by all these novelties are many and of various kinds, but of all of them there is one to which attention is rarely drawn. It is about the fact that the examination and diagnosis of a patient today requires taking into account not only the clinical data, but also their values, something for which professionals have not been sufficiently trained. Many times they do not know how to proceed well, but they do know that they are not doing it correctly. This is what can be called “moral burnout”, for which there is no other correct treatment than the adequate training in values. Something that is done little and, moreover, with programs of very poor quality.</p></span></span></span><span id="sec0215" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0235">Funding</span><p id="par0160" class="elsevierStylePara elsevierViewall">This publication was funded by <span class="elsevierStyleGrantSponsor" id="gs1">GSK</span>. The authors have not received any fee for their contribution.</p></span><span id="sec0220" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0240">Conflicts of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1471352" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1340018" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1471353" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1340017" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:20 [ 0 => array:3 [ "identificador" => "sec0015" "titulo" => "QUESTION 1. What is the best definition of work-related burnout syndrome/burnout? Does the definition and concept of burnout syndrome require any nuance in its application to the medical profession?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions:" ] ] ] 1 => array:3 [ "identificador" => "sec0025" "titulo" => "QUESTION 2. What is the extent of burnout syndrome in the medical profession? Do we have global, European and Spanish data?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions:" ] ] ] 2 => array:3 [ "identificador" => "sec0035" "titulo" => "QUESTION 3. Does simulation exist in this condition? Is there a fictitious and fraudulent burnout syndrome?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Conclusions:" ] ] ] 3 => array:3 [ "identificador" => "sec0045" "titulo" => "QUESTION 4. What are the clearest extrinsic predisposing factors? Are there intrinsic factors?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions:" ] ] ] 4 => array:3 [ "identificador" => "sec0055" "titulo" => "QUESTION 5. What are the most frequent initial clinical manifestations? Who alerts usually first to this diagnosis?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Conclusions:" ] ] ] 5 => array:3 [ "identificador" => "sec0065" "titulo" => "QUESTION 6. How is work-related burnout syndrome diagnosed?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0070" "titulo" => "Conclusions:" ] ] ] 6 => array:3 [ "identificador" => "sec0075" "titulo" => "QUESTION 7. What is the development process or phases through which burnout syndrome progresses? Can burnout syndrome be classified by severity?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0080" "titulo" => "Conclusions:" ] ] ] 7 => array:3 [ "identificador" => "sec0085" "titulo" => "QUESTION 8. Is burnout syndrome contagious between co-workers?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0090" "titulo" => "Conclusions:" ] ] ] 8 => array:3 [ "identificador" => "sec0095" "titulo" => "QUESTION 9. Which medical professionals are most affected? Are there higher-risk specialties?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0100" "titulo" => "Conclusions:" ] ] ] 9 => array:3 [ "identificador" => "sec0105" "titulo" => "QUESTION 10. Could burnout syndrome be included in the list of occupational diseases or is it a work accident?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0110" "titulo" => "Conclusions:" ] ] ] 10 => array:3 [ "identificador" => "sec0115" "titulo" => "QUESTION 11. What is the most appropriate treatment? Is it the same for all professionals or does it have specific aspects?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0120" "titulo" => "Conclusions:" ] ] ] 11 => array:3 [ "identificador" => "sec0125" "titulo" => "QUESTION 12. Can we speak of total cure? What is the risk of relapse?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0130" "titulo" => "Conclusions:" ] ] ] 12 => array:3 [ "identificador" => "sec0135" "titulo" => "QUESTION 13. From the perspective of a hospital occupational health service, what is the personal cost of the burnout syndrome? Is it associated with an increased risk of suicide? What are the essential prevention measures? Who should lead and drive them?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0140" "titulo" => "Conclusions:" ] ] ] 13 => array:3 [ "identificador" => "sec0145" "titulo" => "QUESTION 14. Could we measure the economic-labour costs and for the society of burnout syndrome? And very particularly that of the medical profession?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0150" "titulo" => "Conclusions:" ] ] ] 14 => array:3 [ "identificador" => "sec0155" "titulo" => "QUESTION 15. What is the view of labour lawyers about this problem?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0160" "titulo" => "Conclusions:" ] ] ] 15 => array:3 [ "identificador" => "sec0165" "titulo" => "QUESTION 16. What is the position and view of burnout syndrome on the part of the trade unions?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0170" "titulo" => "Conclusions:" ] ] ] 16 => array:3 [ "identificador" => "sec0175" "titulo" => "QUESTION 17. What knowledge does the non-specialised press have and how does it deal with the burnout syndrome problem?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0180" "titulo" => "Conclusions:" ] ] ] 17 => array:3 [ "identificador" => "sec0185" "titulo" => "QUESTION 18. Do we believe that there is a demand for a large national study on burnout syndrome in the medical profession? What do Medical Colleges think?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0190" "titulo" => "Conclusions:" ] ] ] 18 => array:3 [ "identificador" => "sec0195" "titulo" => "QUESTION 19. What role do Humanities play or should play in the prevention and treatment of burnout syndrome?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0200" "titulo" => "Conclusions:" ] ] ] 19 => array:3 [ "identificador" => "sec0205" "titulo" => "QUESTION 20. What are the ethical aspects of all this?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0210" "titulo" => "Conclusions:" ] ] ] ] ] 6 => array:2 [ "identificador" => "sec0215" "titulo" => "Funding" ] 7 => array:2 [ "identificador" => "sec0220" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-01-31" "fechaAceptado" => "2020-02-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1340018" "palabras" => array:5 [ 0 => "Burnout" 1 => "Burnout in Spain" 2 => "Physicians health" 3 => "Labor risk" 4 => "Health-care professionals" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1340017" "palabras" => array:5 [ 0 => "Quemarse por el trabajo" 1 => "Desgaste profesional" 2 => "Salud de los médicos" 3 => "Riesgos laborales" 4 => "Profesionales de la salud" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This article brings together the views of a working group to deliberate on burnout among physicians in Spain. The document is the result of the answers that different members of the group have prepared to different questions on the subject with conclusions derived from the discussion among all the participants. Burnout is an entity with a high incidence in physicians, with serious work, personal and economic repercussions, whose recognition as a disease is changing in recent years. Particularly affected are some specialties, such as Primary Care, Oncology, Intensive Care Medicine, and Palliative Care. The common factor being an increased qualitative or quantitative demand on the professional. Although it may have a substratum of personal characteristics, it is more commonly associated with extrinsic factors specific to the organisation of work and the management of occupational risks. It involves serious indirect costs for the health system including absenteeism, high financial costs and leads to loss of health and well-being in people who suffer it.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Este artículo reúne las opiniones de un grupo de trabajo para deliberar sobre el síndrome de <span class="elsevierStyleItalic">burnout</span> entre los médicos en España. El documento es el resultado de las respuestas que los miembros del grupo han preparado a diferentes preguntas sobre el tema con conclusiones derivadas de la discusión entre todos los participantes. El <span class="elsevierStyleItalic">burnout</span> es una entidad con una alta incidencia en los médicos, con graves repercusiones laborales, personales y económicas, cuyo reconocimiento como enfermedad está cambiando en los últimos años. Se ven especialmente afectadas especialidades como Atención Primaria, Oncología, Medicina Intensiva y Cuidados Paliativos. El factor común es un aumento de la demanda cualitativa o cuantitativa sobre el profesional. Aunque puede tener un sustrato de características personales, se asocia más comúnmente a factores extrínsecos propios de la organización del trabajo y la gestión de los riesgos laborales. Implica graves costes indirectos para el sistema sanitario, como el absentismo laboral, altos costes económicos, y provoca la pérdida de salud y bienestar de las personas que lo padecen.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Bouza E, Gil-Monte PR, Palomo E, on behalf of the Working Group to deliberate on burnout syndrome in doctors in Spain. Síndrome de quemarse por el trabajo (<span class="elsevierStyleItalic">burnout</span>) en los médicos de España. Rev Clin Esp. 2020;220:359–363.</p>" ] 1 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">The rest of the components of the Working Group to deliberate on burnout syndrome in doctors in Spain are listed in <a class="elsevierStyleCrossRef" href="#sec0225">Appendix A</a>. The full text is available as additional material in <a class="elsevierStyleCrossRef" href="#sec0230">Appendix B</a>.</p>" "identificador" => "fn0005" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:2 [ 0 => array:3 [ "apendice" => "<p id="par0170" class="elsevierStylePara elsevierViewall">Bouza E. (Hospital General Universitario Gregorio Marañón, Madrid)</p> <p id="par0175" class="elsevierStylePara elsevierViewall">Cortell-Alcocer M. (Ibermutuamur, Valencia).</p> <p id="par0180" class="elsevierStylePara elsevierViewall">Del Rosario G. (Agencia EFE Salud, Madrid).</p> <p id="par0185" class="elsevierStylePara elsevierViewall">Gil-Monte P.R. (Universitat de València, Valencia).</p> <p id="par0190" class="elsevierStylePara elsevierViewall">González J. (Universidad Complutense, Madrid).</p> <p id="par0195" class="elsevierStylePara elsevierViewall">Gracia D. (Fundación Ciencias de la Salud, Madrid).</p> <p id="par0200" class="elsevierStylePara elsevierViewall">Martínez Moreno A. (Universitat de València, Valencia).</p> <p id="par0205" class="elsevierStylePara elsevierViewall">Melero Moreno C. (Hospital Universitario 12 de Octubre, Madrid).</p> <p id="par0210" class="elsevierStylePara elsevierViewall">Molero García J.M. (SIME-CSIT, Unión Profesional, Madrid).</p> <p id="par0215" class="elsevierStylePara elsevierViewall">Montilla P. (Hospital General Universitario Gregorio Marañón, Madrid).</p> <p id="par0220" class="elsevierStylePara elsevierViewall">Palomo E. (Fundación Ciencias de la Salud, Madrid).</p> <p id="par0225" class="elsevierStylePara elsevierViewall">Peñacoba E. (Simmons & Simmons LLP, Madrid).</p> <p id="par0230" class="elsevierStylePara elsevierViewall">Rodríguez Créixems M. (Hospital General Universitario Gregorio Marañón, Madrid).</p> <p id="par0235" class="elsevierStylePara elsevierViewall">Rodríguez de la Pinta M.L. (Hospital Universitario Puerta de Hierro, Majadahonda, Madrid).</p> <p id="par0240" class="elsevierStylePara elsevierViewall">Romero Agüit S. (Consejo General de Colegios Oficinales de Médicos, Madrid).</p> <p id="par0245" class="elsevierStylePara elsevierViewall">Sartorius N. (Plan de Atención Integral al Profesional Sanitario Enfermo [PAIPSE], Conserjería de Sanidad, Madrid).</p> <p id="par0250" class="elsevierStylePara elsevierViewall">Soriano J.B. (Hospital Universitario de la Princesa, Madrid).</p>" "etiqueta" => "Appendix A" "identificador" => "sec0225" ] 1 => array:4 [ "apendice" => "<p id="par0260" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix B" "titulo" => "Supplementary data" "identificador" => "sec0235" ] ] ] ] "multimedia" => array:1 [ 0 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 679284 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Marco actual del suicidio e ideas suicidas en personal sanitario" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. 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