Burnout and mental distress strongly related to errors by US surgeons

Major medical errors self-reported by American surgeons are strongly related to both burnout and depression. Those findings appear today in the online edition of Annals of Surgery. The Mayo Clinic-led study included collaborators from Johns Hopkins and the American College of Surgeons.

In the confidential study, nearly 9 percent of U.S. surgeons responding said they made a major error in the three months prior to being surveyed. Over 70 percent attributed the error to themselves rather than a systemic or organizational cause. Results showed the components of surgeon burnout - emotional exhaustion, depersonalization and perception personal accomplishments - were related to errors; as was surgeons' "mental quality of life" including depression.

"These results suggest that a surgeon's personal mental health including burnout may have an effect on quality of care," says lead author Tait Shanafelt, M.D. "Our aim is to encourage more research to find ways to reduce distress among surgeons and to provide better support when errors occur." The authors say medical errors can haunt surgeons for years and contribute to distress.

Of the 7,905 surgeons participating in the survey, 8.9 percent or 700 reported making recent medical errors that they considered major. All participating surgeons also completed standardized survey tools to measure burnout, quality of life, and symptoms of depression. They also provided information on a variety of personal and professional characteristics. Researchers say they found no relation between errors and the work setting, method of compensation, number of nights on call per week, or number of hours worked. According to researchers, that finding suggests that reducing work hours for practicing surgeons may have little impact on limiting errors unless burnout is also addressed. They point out that the study has its limitations, as it relies on self-perception of errors and their severity. The researchers were also unable to determine if the association between distress and errors is causal.

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Other authors on the study include Charles Balch, M.D., and Julie Freischlag, M.D., from Johns Hopkins; Gerald Bechamps, M.D., Winchester Surgical Clinic; Tom Russell, M.D., and Paul Collicott, M.D., American College of Surgeons; and Lotte Dyrbye, M.D., Daniel Satele, Paul Novotny, and Jeff Sloan, Ph.D., all from Mayo Clinic. The study was commissioned and supported by the American College of Surgeons. Dr. Bechamps was chairman of the ACS Committee on Physician Competency and Health at the time of the survey. Drs. Frieschlag, Balch, and Collicot are all Fellows of the ACS. Dr. Russell is executive director of the ACS.

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