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Burnout among physicians has negative consequences on the quality of care they provide, the results of a large-scale systematic review and a meta-analysis.
The investigators found that physician burnout is associated with a two times higher likelihood of unsafe care, unprofessional behavior, and low satisfaction rates among patients.
This analysis shows that physician burnout can "compromise patient care" and that "reversing this risk should be considered a fundamental goal of health policies around the world," explained Maria Panagioti, PhD, University of Manchester. United Kingdom, write.
The study was published online on September 4 JAMA Internal Medicine.
An epidemic
The depletion of doctors has reached epidemic levels. The Medscape Physician Lifestyle 2017 report suggests that 50% of doctors in the United States report signs of burnout; this represents an increase of 4% in one year.
"However, the consequences of burnout on patient care are less well known, even though medical errors cost the health systems billions of dollars each year," Panagioti said. Medscape Medical News.
The results of the meta-analysis, which included 47 relevant studies and more than 42,000 physicians (59% male, median age 38, range 27 to 53 years), indicate that burnout physicians are associated with increased risk for the safety of incident patients; poor quality of care due to lack of professionalism; and low patient satisfaction.
| Result | Odds ratio (95% CI) |
|---|---|
| Patient safety incident | 1.96 (1.59 to 2.40) |
| Poor quality of care | 2.31 (1.87 – 2.85) |
| Low patient satisfaction | 2.28 (1.42 – 3.68) |
| IC, confidence interval | |
A closer look at the individual components of burnout found that symptoms of depression / emotional exhaustion were associated with a higher risk of participating in patient safety incidents (OR, 2.38; 95%: 1.84-2.92).
Depersonalization associated with burnout was associated with a probability of more than four times higher for low patient-reported satisfaction (OR, 4.50, 95% CI, 2.34 – 8.64).
"The results are generally worrying but not surprising," Panagioti said. Medscape Medical News. "Current interventions to improve patient safety have focused primarily on the identification and monitoring of vulnerable patients and sometimes vulnerable systems, but have overlooked the depletion of doctors," she noted.
"The most alarming" Finding
"The most alarming finding," she noted, was that burnout was associated with nearly four times the risk of unprofessional behavior, particularly among residents and early-stage physicians ( OR 3.39, 95% CI, 2.38-4.40).
Overall, these results demonstrate that physician burnout is associated with a reduction in the efficiency of health care systems to provide high quality, safe care to patients, note the researchers. .
"Our findings point out that health care organizations have a duty to invest in large-scale coordinated strategies to reduce the burnout of doctors," Panagioti said. Particular attention should be given to residents and doctors at the beginning of their careers, she said.
"Innovative interventions are needed to mitigate the top three contributing factors to medical errors: vulnerable patients, vulnerable systems, and exhausted physicians." Inability to deal with physician fatigue puts patient safety at risk and the effectiveness of health care ".
Commenting on the results for Medscape Medical NewsMark Linzer, MD, University of Minnesota and Hennepin Healthcare Systems, Minneapolis, said the new study "reinforces the link between burnout and quality of care. It is still difficult to say whether organizations burn clinicians or clinicians exhausted themselves.
"There has been a great interest in fighting burnout," Linzer said. Medscape Medical News, "but there is no data yet indicating if burnout is decreasing nationwide."
He noted that "workflow redesign is effective at reducing burnout, but we still need to test what specific types of workflow redesigns are most effective.
"With nearly half of US doctors experiencing symptoms of burnout, there is still work to be done to understand how to reduce it and what we can expect," Linzer writes in a comment.
The study was funded by the School of Primary Care Research of the National Institutes of Health Research (NIHR) of the United Kingdom and the Center for Translational Research on Patient Safety at NIHR Greater Manchester. The authors revealed relevant financial relationships. Dr. Linzer is supported by the American College of Physicians and the Association of Leaders and Leaders in General Internal Medicine as part of the Wellness Champion Training and receives support for research projects on the well-being of the doctors of the American Medical Association.
Trainee med Posted online September 4, 2018. Summary, Commentary
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