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Doctors who reported at least one major symptom of burnout were more than twice as likely to report a major medical error within the previous 3 months, according to a new study published online today in Mayo Clinic Proceedings.

The study is based on a cross-sectional, observational survey, which precludes conclusions about causality or the association’s directionality. But “it is conceptually likely that the two are reciprocal,” write Daniel Tawfik, MD, MS, an instructor of pediatric critical care medicine at the Stanford University School of Medicine in Palo Alto, California, and colleagues.

They cite previous research showing that “self-perceived medical errors were found to predict subsequent burnout, while burnout was also found to predict subsequent perceived medical errors.”

Tawfik told Medscape Medical News the most surprising finding from the new data is the strength of the relationship between burnout and errors after accounting for other factors, including work-safety grades.

“It shows that those work-safety grades don’t tell the whole picture,” he said. “They are an important reflection of practices in a unit, but they’re only telling part of the story.”

More Burnout, More Errors

The researchers used data from the American Medical Association Physician Masterfile to contact 94,032 physicians between August and October 2014, including physicians across all specialties. The invitation said the anonymous survey was about factors contributing to doctors’ satisfaction and did not mention burnout. Overall, 35,922 physicians opened an invitation and 6695 (19%) completed the survey. Two thirds of the respondents (67%) were male; the median age was 56 years. The respondents worked a median of 50 hours a week.

The 60-question survey asked about burnout; well-being; fatigue; depression; suicidal thoughts; recent medical errors; and physicians’ age, sex, relationship status, specialty, practice setting, and hours worked per week. Physicians were also asked to give their work area “an overall grade on patient safety” with one of the following: A (excellent), B (very good), C (acceptable), D (poor), or F (failing).

Standardized survey tools were used for burnout and well-being questions, and fatigue measured how the doctor felt in the past week on a 0-to-10 Likert scale (0 = worst); scores of 4 or lower were classified as excessive fatigue.

The medical errors question asked, “Are you concerned you have made any major medical errors in the last 3 months?” This wording, the authors explain, “is intended to identify recent events internalized as a major medical error; events identified in this way have been found to have a high correlation with actual medical errors.”

Just over half (54%) of respondents reported at least one major symptom of burnout. One third (33%) reported excessive fatigue, and 6.5% reported suicidal ideation within the prior 12 months.

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