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Physicians reporting burnout twice as likely to make medical mistakes

Physicians with burnout reported medical errors at double the rate of other clinicians after adjusting for specialty, work hours, fatigue and work unit safety rating, according to findings recently published in Mayo Clinic Proceedings.

“A nuanced understanding of the potentially bidirectional connection between physician well-being and patient safety remains in its infancy,” Daniel S. Tawfik, MD, of the department at pediatrics at Stanford University and colleagues wrote.

Researchers reviewed survey responses from 6,695 actively practicing physicians, of whom 55% reported burnout symptoms, 33% reported excessive fatigue and 6.5% recently thought about suicide. Eleven percent of all physicians reported a “major medical error” and another 3.9% had a poor or failing patient safety grade in their primary work area during the previous 3 months.

In addition, multivariable modeling showed perceived errors were independently more likely to be reported by physicians with burnout (OR = 2.2; 95% CI, 1.8-2.8), fatigue (OR = 1.4; 95% CI 1.1-1.6), and in those who physicians who received ‘F’ grades for safety (OR = 4.4; 95 CI, 2.06-9.28). The most common errors were mistakes in judgment (39%), wrong diagnosis (20%), or technical mistake (13%). Fifty-five percent of the errors did not impact patient outcome, but 5.3% led to significant permanent morbidity and 4.5% led to a patient’s death. The specialties with the most providers reporting overall errors were radiology (23%), neurosurgery (22%) and emergency medicine (21%).

Tawfik and colleagues also found that physicians reporting errors were more likely to have burnout symptoms (78% vs. 52%) fatigue (47% vs 31%) and have had recent thoughts about suicide (13% vs 6%) (P < .001) than those who did not report errors.

“Participation in this study was voluntary and thus susceptible to response bias. However, the observable demographic characteristics of the sample were well-aligned with the complete population of U.S. physicians, and early vs. late responders did not meaningfully differ, suggesting that this study carries relevance for the population of physicians as a whole,” Tawfik and colleagues wrote.

“Today, most organizations invest substantial resources and have a system-level approach to improve safety on every work unit. Very few devote equal attention to address the system-level factors that drive burnout in the physicians and nurses working in that unit,” study co-author Tait D. Shanafelt, MD, of the department of medicine at Stanford University said in a press release. “We need a holistic and systems-based approach to address the epidemic of burnout among health care providers if we are truly going to create the high-quality health care system we aspire to.” – by Janel Miller