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The emotional effects of medical errors on physicians

Physicians—particularly surgeons—hold themselves to high standards of excellence, reports the August 2007 issue of The Joint Commission Journal on Quality and Patient Safety. As a result, medical errors produce high levels of stress, anxiety, and sleep loss in most doctors, according to the results of a survey of more than 3,000 physicians in the United States and Canada.

The survey—which was conducted between July 2003 and June 2004 and included internal medicine, pediatric, family medicine physicians as well as surgeons—asked about the physicians’ experiences with medical errors and error disclosure. Physicians were divided into three groups depending on the types of error that had occurred: “near miss” (7 percent), “minor error” (36 percent), and “serious error” (57 percent).

More than 80 percent of physicians experienced at least one form of emotional distress or job-related stress after making an error. The most common reactions included increased anxiety about making future errors (61 percent), loss of confidence (44 percent), reduced level of job satisfaction (42 percent), difficulties with sleep (42 percent), and a concern about harm to their reputation (13 percent).

Physicians who reported a serious error were more likely to be anxious about making a future error, to have issues with their self-confidence and job satisfaction, and to experience insomnia, as compared with their colleagues who reported minor errors or near misses.

Most respondents—92 percent—reported that hospitals and healthcare organizations offered little to no assistance in helping them cope with the stress and anxiety that followed making a medical error. More than one third (37 percent) felt that their institutions gave them no support whatsoever, even though 8 out of 10 reported being “somewhat” to “very” interested in receiving counseling after a serious error had occurred.

The authors of the study recommend that hospitals and other healthcare organizations make a broad range of services available to physicians, including critical incident stress debriefing, telephone or in-person counseling with therapists or physicians with experience with medical errors, and discussions of how physician leaders coped after their own error experiences. They also note that therapeutic conversations are generally protected from the discovery process in the event of a malpractice lawsuit.

Waterman AD, Garbutt J, Hazel E, et al: The emotional impact of medical errors on practicing physicians in the United States and Canada. Jt Comm J Qual Patient Saf. 2007;33:467-476.

October 2007 AAOS Now
http://www.aaos.org/news/bulletin/oct07/managing6.asp