Nearly 9% of nearly 8,000 surveyed members of the American College of Surgeons said they'd made a major medical error in the last three months, and one-third attributed the mistake to a "lapse in judgment," rather than a system failure.
Reporting those errors was strongly associated with burnout and depression manifested by emotional exhaustion, depersonalization, and decline in a sense of personal accomplishment.
Those are the results from the latest in a series of reports on the mental health of America's surgeons from Charles M. Balch, MD, colleagues at Johns Hopkins University, and others at the Mayo Clinic and the Winchester Surgical Clinic. It was published yesterday in the online version of the Annals of Surgery.
"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 Balch, a professor of surgery. "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."
The study found that 40% of the surgeons who responded to the survey said they were burned out.
The authors said the findings are important because, while surgeons don't make more errors than physicians in other disciplines, "errors made by surgeons may have more severe consequences for patients due to the interventional nature of surgical practice."
"For example, reporting a major medical error in the last three months was associated with a 7-point increase ... in emotional exhaustion on the MBI (Maslach Burnout Inventory questionnaire) and roughly a doubling in the risk of screening positive for depression," the authors wrote.
The mean age of those reporting medical errors was three years younger than those who did not report errors (49 versus 52). Surgeons who worked an average of 4.6 more hours a week were more likely to report a recent medical error (63.5 hours versus 58.9) and spent an additional hour per week in the operating room. They also had slightly more nights on call per week.
General surgeons were more likely to report errors than obstetrician gynecologists, plastic surgeons, and otolaryngologists.
The report said the rate of reporting perceived mistakes seemed linked to career satisfaction. "Surgeons reporting recent errors were less likely to report they would become a physician or a surgeon again and were also less likely to recommend their children pursue a career as a physician or surgeon."
Surgeons reporting a medical error were also associated with higher levels of burnout. "Each 1-point increase in depersonalization was associated with an 11% increase in the likelihood of reporting an error while each 1-point increase in emotional exhaustion was associated with a 5% increase," according to the report.
"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," said Julie A. Freischlag, MD, chair of the Department of Surgery at Johns Hopkins and one of the study's authors.
In August, the same group of researchers led by Balch reported in Annals of Surgery that burnout is common among American surgeons and is the single greatest predictor of surgeons' satisfaction with career and specialty choice.
With Los Angeles County supervisors expected to sign off next week on plans to partner with the University of California to reopen the Martin Luther King Jr. medical facility, the hard work—creating a new hospital from the ashes of the old by 2013—begins. In many respects, the partnership with UC would wipe the slate clean, creating a nonprofit company overseen by a seven-member board of directors who would decide how to run the facility and whom to hire—a key issue to critics who cite the county's poor history of dealing with problematic employees at the Willowbrook hospital. County supervisors closed King to all but outpatient care after the facility failed a make-or-break inspection that meant the loss of $200 million in federal funds. The final failure came after repeated findings that inadequate care had led to patient injuries and deaths.
At least one-fourth of all U.S. adults are obese. About one in five smokes. Fewer than half get the recommended amount of physical activity. Despite Americans' poor lifestyle choices and the chronic problems they spawn, healthcare reform legislation that Congress is considering would do little to encourage people to live healthy lives, according to health experts. Advocates say Congress is missing an opportunity to expand medicine's focus beyond the diagnosis and treatment of illness. They say lawmakers should do more to boost efforts to prevent the onset of diseases by improving the mental and physical well-being of Americans.
Health experts say it would be great if national health reform legislation would render San Francisco's groundbreaking health program unnecessary—but they don't see that happening anytime soon. None of the bills under consideration in Congress promises to cover everyone living in the United States, leaving some people without coverage. Those include new immigrants who can't afford coverage but are not yet eligible for public programs, low-income people who wouldn't qualify for subsidies, and illegal immigrants. These are among the groups of people who have health coverage under Healthy San Francisco.
Abortion-rights groups, acknowledging they were caught off guard by a last-minute amendment toughening abortion restrictions in the House healthcare bill, are mobilizing to ensure that doesn't happen in the Senate. Activists hope to flood Washington to rally and lobby on Dec. 2, during the week that Senate floor debate begins. The Center for Reproductive Rights has aired television ads criticizing the restrictions. On Tuesday, activists will announce the creation of the Coalition to Pass Health Care Reform and Stop Stupak, a network of more than 30 groups.
For Republicans, the Saturday vote on healthcare in the Senate was the first skirmish in a longer battle aimed at frustrating White House ambitions and ensuring that Democrats bear full responsibility for legislation the GOP sees as increasingly unpopular with Americans. With the 2010 election year looming, Republicans forced Democratic leaders to demonstrate that they can pull together a 60-vote majority for the bill. All 58 Democrats and the two independents allied with the party joined together, voting to avert a Republican filibuster that threatened to stall action. The defeat isn't likely to cause a fundamental rethinking in Republicans' strategy of delaying the bill and pointing to what they see as its flaws. Even if a bill ultimately passes, Republicans hope to delay that moment until well into 2010—when all seats in the House and one-third of those in the Senate will be contested.