Physician burnout a key driver of medical errors

A doctor in Gainesville, Fla., was recorded on camera yelling at a patient who was complaining of long wait times. He said in a statement Wednesday that the woman had been threatening the office staff with violence. (iStock)

Burned-out doctors are more likely to make major medical errors, regardless of workplace safety measures, new research shows.

“Just trying to fix the setting of health care environments in order to prevent errors is not sufficient. We also need to address the actual underlying human factors that contribute to errors, specifically looking at physician burnout,” Dr. Daniel Tawfik of Stanford University School of Medicine in California, the study’s lead author, told Reuters Health in a phone interview.

Burnout is a work-related syndrome characterized by emotional exhaustion, cynicism and feeling less effective on the job, Tawfik explained. Health care workers - and anyone else with a stressful job involving intensive interaction with other people - are at particularly high risk of burnout.

More than half of physicians are estimated to have burnout, while 45 percent report excessive fatigue, Tawfik and his colleagues note in their report in Mayo Clinic Proceedings.

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There is growing evidence that physician burnout may impact patient safety, the authors add, possibly by contributing to medical errors, which are responsible for up to 200,000 deaths in US hospitals every year, the authors add.

To investigate, they surveyed 6,695 U.S. doctors on whether they experienced symptoms of burnout or fatigue or suicidal thoughts and whether they had made any major medical errors in the previous three months. The demographics and specialties of physicians in the survey were similar to what’s seen in the overall U.S. physician population.

Overall, 10.5 percent of study participants reported having made a major medical error recently, including errors in judgment, a mistaken diagnosis, or a technical error. Fifty-five percent of the errors did not affect patient outcomes, 5.3 percent led to permanent health problems and 4.5 percent to a patient’s death.

Seventy-eight percent of the doctors who reported errors had symptoms of burnout, compared to 52 percent of those who did not report errors. The physicians who made mistakes were also more likely to have high levels of fatigue (78 percent vs. 52 percent), and to have had recent suicidal thoughts (13 percent vs. 6 percent).

“The relationship between physician burnout and medical errors was very strong even after we adjusted for work unit safety grades,” Tawfik said.

“The study didn’t specifically look at which direction the relationship is going, whether burnout is causing errors or errors are causing burnout,” he added. “This study was really just looking at the association between the two. It really seems to be both directions. Physicians who are more burned out are more likely to report errors in the future and physicians who report errors are more likely to report burnout in the future.”

But this discouraging negative spiral could quickly become a positive spiral “if you were to move it in the other direction,” Tawfik added, noting that even a one-point change on the 30- to 55-point scales used to measure burnout symptoms was linked to fewer reported medical errors.

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“Patients should feel empowered to speak up any time they feel like there’s something that is an error or there is something that seems to be putting them at risk,” Tawfik said. “Any health care professional, whether they’re experiencing burnout or not, should be receptive to that.”

In a separate study published the Journal of the American Board of Family Medicine, Dr. Donna Shelley of NYU School of Medicine and her colleagues found just 13.5 percent of doctors working in small independent primary care practices in New York City reported burnout, versus about 55 percent of doctors overall.

“These findings are particularly relevant for physicians in small practices, but they also provide clues that the ability of any organization’s leadership to react to physician input may be a key driver of burnout,” Tawfik, who did not participate in the NYU study, said. “Although these characteristics are often more easily achieved in small practice settings, they may be no less important in large organizations. Burnout is not just an individual-level problem, and organizational culture, flexibility, and support at work are all drivers of burnout and engagement relevant to physicians in any size organization.”