Physician burnout affects not only the health of the doctors who are experiencing it, but also, potentially, the health of their patients, according to a study published this week in the journal Mayo Clinic Proceedings.
The study found that doctors who report symptoms of burnout — overwhelming exhaustion, feelings of cynicism and detachment from the job — are twice as likely to make a major medical error as their non-burned-out peers.
The study also found that physician burnout may be responsible for as many — or perhaps more — medical errors than unsafe environments and practices in hospitals and clinics.
These findings are troubling, for, as background information in the study points out, previous research has estimated that medical errors in the United States cause 100,000 to 200,000 deaths each year. It’s also believed that the annual number of serious nonfatal medical errors in the U.S. — including ones that cause permanent harm to the patient — is 10 to 20 times higher.
Burnout among U.S. physicians is also common — affecting more than 50 percent of doctors, according to some studies.
“Today, most [hospitals and clinics] invest substantial resources and have a system-level approach to improve safety on every work unit,” said Dr. Tait Shanafelt, the study’s senior author and an associate dean at the Stanford University School of Medicine, in a released statement. “Very few devote equal attention to address the system-level factors that drive burnout in the physicians and nurses working in that unit,” he added.
A detailed questionnaire
For the current study, Shanafelt and his colleagues wanted to see how physician burnout contributes to medical errors. They surveyed 6,695 physicians in active practice across the United States. More than 40 percent of the physicians were men, and their median age was 56 (slightly older than U.S. physicians generally). The surveyed physicians reported working an average of 50 hours per week, with one night per week (on average) of being on call. Their medical specialties were representative of the overall U.S. physician population.
The physicians answered questions designed to determine whether they had experienced burnout, fatigue, depression and/or suicidal thoughts. Fifty-five percent of the respondents reported symptoms of burnout — a figure in line with the findings of other studies on the topic.
The physicians were then asked if they had made any major medical errors in the previous three months. More than one in 10 (10.5 percent) of the physicians reported that they had — a percentage that is also consistent with previous studies.
The three most common errors were a misstep in medical judgment, a wrong diagnosis or a technical mistake. Most (55 percent) of those errors had no perceived effect on the patient’s outcome, but 5.3 percent resulted in a “significant permanent” health problem and 4.5 percent in the patient’s death.
A link with medical errors
The researchers then looked at the survey’s data to see if they could uncover an association between the physician’s reports of burnout and their reports of medical errors. They found that 78 percent of the doctors who reported errors had symptoms of burnout. That compared to 52 percent of the doctors who did not report errors.
A greater proportion of the physicians who reported errors were also more likely to have high levels of fatigue — 78 percent versus 52 percent of those who didn’t report errors.
Although less common than burnout, symptoms of depression and thoughts of suicide were strongly associated with medical errors, too. That finding was not unexpected, however.
“Blame-related distress among physicians following adverse patient outcomes, termed second victim syndrome,commonly manifests as depression and suicidality in addition to frustration, anxiety, burnout, and intent to leave medical practice,” Shanafelt and his colleagues explain in their paper.
The survey also asked physicians to give a patient-safety score (from “excellent” to “failing”) to the hospital or clinic work unit in which they practiced. Those results showed that the rates of medical errors were significantly higher in medical work units — even “excellent” ones — if physicians working on that unit reported high levels of burnout.
“This indicates both the burnout level as well as work unit safety characteristics are independently related to the risk of errors,” said Shanafelt.
Needed: a two-pronged approach
The study comes with some important caveats. Its findings reflect only an association, not a cause-and-effect relationship, between physician burnout and an increased incidence of medical errors. Other factors, not addressed in the study, might explain the link.
Also, both burnout and medical errors were self-reported by the physicians, and self-reports can be inaccurate. Furthermore, participation in the study was voluntary. The participants may not, therefore, have been entirely representative of physicians across the country.
Still, the findings are in line with those from other studies that have found physician burnout to be a major problem in medicine — for patients as well as for doctors.
“Up until just recently, the prevailing thought was that if medical errors are occurring, you need to fix the workplace safety with things like checklists and better teamwork,” said Dr. Daniel Tawfik, the study’s lead author and an instructor in pediatric critical care medicine at Stanford, in a released statement.
“This study shows that that is probably insufficient,” he added. “We need a two-pronged approach to reduce medical errors that also addresses physician burnout.”
FMI: You’ll find an abstract of the study on the Mayo Clinical Proceedings website, but the full study is behind a paywall.