key: cord-0761817-22cpwonw
authors: Esquerda, M.; Teres, J.
title: COVID-19 pandemic, professionalism, and the social contract
date: 2021-06-30
journal: Rev Clin Esp (Barc)
DOI: 10.1016/j.rceng.2021.04.003
sha: 57a4d6a936e79e0e3b60f49ebf0bfb741bf3c056
doc_id: 761817
cord_uid: 22cpwonw

nan

from extravagant political promises and the demagogy of unlimited power without obligations. 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. 4 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. [4] [5] [6] [7] Ofri 8 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. 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 Health professionals have responded to the increased demand in an exemplary manner, according to the outdated contract, with noble displays of altruism and generally going beyond the call of duty, including taking on the risk of infection with insufficient protection,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. 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. 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". 1 In creating this coherence, certain factors must address adapting contracts and salaries according to the le vel 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, 9 with participation in decisionmaking at all levels. Lemaire 4 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. 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. The medical profession in the 21 st 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.

Contrato social y valores en la profesión médica

The third logic

Why are doctors so unhappy?

Burnout among doctors

Descriptive study of assotiation between quality of care and empathy and burnout in primary care

Burnout syndrome in internal medicine specialists and factors associated with its onset

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The Covenant

Physician Burnout, Interrupted

The authors declare they do not have any conflicts of interest.

Los autores declaran que no tiene ningún conflicto de interés.J o u r n a l P r e -p r o o f