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.