Depression, exhaustion, and patient safety

Study links surgeons' mental well-being, errors

Surgeons who are burned out or depressed are more likely to say they had recently committed a major error on the job, according to the largest study to date on physician burnout. The findings suggest that the mental well-being of the surgeon is associated with a higher rate of self-reported medical errors, something that might undermine patient safety more than the fatigue that is often blamed for many of the medical mistakes.

Although surgeons don't appear more likely to make mistakes than physicians in other disciplines, surgical errors may have more severe consequences for patients due to the interventional nature of the work. Some estimate that as many as 10% of hospitalized patients are affected by medical errors.

"People have talked about fatigue and long working hours, but our results indicate that the dominant contributors to self-reported medical errors are burnout and depression," said Charles M. Balch, MD, a professor of surgery at the Johns Hopkins University School of Medicine and one of the study's leaders. "All of us need to take this into account to a greater degree than in the past. Frankly, burnout and depression hadn't been on everybody's radar screen."

There were 7,905 surgeons who responded to a June 2008 survey commissioned by the American College of Surgeons for a study led by researchers from Johns Hopkins University School of Medicine and the Mayo Clinic. Nine percent reported having made a major medical mistake in the previous three months. Overall, 40% of the surgeons who responded to the survey said they were burned out.

Researchers asked a variety of questions, including queries that rated three elements of burnout — emotional exhaustion, depersonalization, and personal accomplishment — and others that screened for depression. Each 1-point increase on a scale that measured depersonalization, a feeling of withdrawal or of treating patients as objects rather than as human beings, was associated with an 11% increase in the likelihood of reporting an error. Each 1-point increase on a scale measuring emotional exhaustion was associated with a 5% increase.

Mistakes also varied by specialty. Surgeons practicing obstetrics/gynecology and plastic surgery were much less likely to report errors than general surgeons.

Researchers acknowledged the limitations of self-reporting surveys, saying they couldn't tell from their research whether burnout and depression led to more medical errors or whether medical errors triggered burnout and depression among the surgeons who made the mistakes. The results were published online in the Annals of Surgery and will be published in the printed journal in a spring issue.

Notably, the research shows that the number of nights on call per week and the number of hours worked were not associated with reported errors after controlling for other factors. Julie A. Freischlag, MD, chair of the Department of Surgery at the Johns Hopkins University School of Medicine and another of the study's authors, said, "The most important thing for those of us who work with other surgeons who do not appear well is to address it with them so that they can get the help they need."