Doctors who err are prone to burnout, more mistakes
Doctors who err are prone to burnout, more mistakes
Study: Perception, not actual error, is key
If a physician makes a significant error, it may be a good idea to keep an eye on him or her and watch for signs of serious burnout and more mistakes to come. That is the warning from a new study that says one error often is followed by another.
Interestingly, there doesn't even need to be an actual error for this pattern to start. Physicians who believe they have committed a major medical error in the previous three months, whether they really did or not, are more likely to report symptoms of burnout and depression, says Tait Shanafelt, MD, a physician at the Mayo Clinic in Rochester, MN, who led the study team. The burnout and worry over the previous error may also increase the risk of a future error, the study suggests.1
A 1999 Institute of Medicine report said as many as 100,000 patients die each year because of preventable medical errors. Since then, several studies of physicians in medical and surgical residency programs have found that a significant proportion of medical trainees make medical errors, Shanafelt notes. Previous studies asking residents about errors had taken a single snapshot in time or asked residents to look back on their entire residency and recollect whether they had made a serious error. The Mayo study is the first to follow a group of residents prospectively, which enabled researchers to examine the relationship between physician distress and the future likelihood of an error, Shanafelt says.
"We knew from previous studies some of the effects on physicians of making an error," Shanafelt explains. "This new study takes it a step further, enabling us to see the time relationship between errors and burnout, and vice versa."
The researchers followed 184 medical residents from 108 U.S. and international medical schools who were continuing their training in the Mayo Clinic Rochester Internal Medicine Residency program. Residents completed quarterly surveys asking, "Are you concerned you have made any major medical errors in the last three months?" They also completed validated survey instruments to measure quality of life and burnout and to screen for depression.
On average, 14.7% of the participants reported making an error in the previous three months on each quarterly survey. Those who reported an error experienced substantially higher levels of burnout and were more than three times more likely to have a screening test indicate possible depression.
Future errors more likely
The connection between errors and various measures of distress also operated in reverse; those who scored high on burnout measures were twice as likely to report an error in the next three months as those with low burnout. The study also found a trend toward increased future errors for physicians with symptoms of depression. "Not only are physicians who perceive they have made errors more likely to experience burnout and symptoms of depression, but those who are distressed appear more likely to make an error in the next three months," Shanafelt says.
Colin West, MD, PhD, another author of the study and a physician at the Mayo Clinic, says the study findings should be useful to risk managers. Much of the quality improvement movement has rightly focused on adjusting systems to prevent errors, he says, "but our study highlights the human dimension. If a physician is experiencing personal distress, it makes a future error more likely. Making an error also has a strong effect on burnout, empathy, and depression, and this forms a vicious cycle that can negatively impact patient care."
Shanafelt and West urge risk managers to establish efforts to prevent, identify, and treat burnout in physicians, for the benefit of their patients. A good first step, they say, is to meet with department chairs and other physician leaders to discuss the risk and look for ways to intervene.
(Editor's note: A good resource for addressing physician burnout is the American College of Physicians web site at www.acponline.org. Enter "physician burnout" in the search box to find multiple sources of information.)
Reference
1. West CP, Huschka MM, Novotny PJ, et al. Association of perceived medical errors with resident distress and empathy: A prospective longitudinal study. JAMA 2006; 296:1,071-1,078.
If a physician makes a significant error, it may be a good idea to keep an eye on him or her and watch for signs of serious burnout and more mistakes to come.Subscribe Now for Access
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