A report in the Sept. 23/30 2009 issue of the Journal of the American Medical Association concludes that fatigue isn’t the only contributor to medical errors among medical residents but financial woes, family concerns and other elements of distress play also a major role in potentially fatal mistakes.
The study team used data from 430 internal medicine residents, who were surveyed quarterly from 2003 through 2008. During the surveys they were asked about their medical errors, if any, quality of life, fatigue, burnout, depression and sleepiness.
39 percent of the 378 doctors who responded to the questions about medical errors said they had made at least one major error.
This is also a study that found a connection between medical errors and fatigue. For every point increase in the fatigue score, doctors were 14 percent more likely to make a medical error. In addition, for every point increase in the sleepiness score, doctors were 10 percent more likely to err.
Researchers concluded that medical errors were also linked to burnout, depression and overall quality of life.
Is this ground-breaking data? Not at all and Dr. David J. Birnbach, a professor and vice provost of the University of Miami and associate dean and director of the UM-Jackson Memorial Hospital Center for Patient Safety at the Miller School of Medicine said, “We’ve known for a long time that fatigue in anyone is bad, and medical personnel who are very fatigued tend to make more errors. We in the United States have made a dramatic change in the way we train residents to limit the number of hours they work. That’s regulated at a federal level.”
Sure, this is a good beginning but it can be only just a beginning. Additional changes need to be:
- Focus on self-management skills which includes stress control, time management, and life skills for residents and physicians
- Continuous training on interpersonal skills to improve the relationship with patients and the teamwork with staff to ensure patient safety and quality care.
(Both coaching / training on self-management and interpersonal skills can be provided in a CME setting.) - Good role-modeling from mentors and professors in medical school and residency.
Another report in the same issue of JAMA claimed that doctors who participated in a program that included meditation, self-awareness exercises and stories of “meaningful clinical experiences” improved their well-being, had more empathy toward patients and were less “emotionally exhausted” or burned out, the researchers found.
The study demonstrated that primary care physicians participating in a continuing medical education program that focused on self-awareness experienced improved personal well-being, including burnout and improved mood, the researchers wrote. “They also experienced positive changes in empathy and psychosocial beliefs, both indicators of a patient-centered orientation to medical care.”
Healthcare organizations and physicians have been making the critical mistake that their continuing education has been focusing almost exclusively on clinical skills.
Several years ago research by the Dale Carnegie Institute concluded that 15% of a person’s success (physicians included) is dependent on their technical skills and 85% is dependent on their interpersonal and self-management skills. This doesn’t mean that clinical training can be neglected but the best clinical skills and knowledge will never be leveraged without appropriate interpersonal and self-management skills.
The Balanced Physician Program is a continuing medical education program that can be brought into any healthcare environment. It focuses on self-awareness, self-management, social awareness and interpersonal skills and addresses the personal well-being of the physicians and their professional performance. The proactive / preventative approach and the combination of training and coaching ensure that the acquired skills will be implemented in every physician’s life.
Physicians who feel control of their personal life; physicians who have a positive and strong relationship with colleagues and staff and physicians who are able to communicate effectively with their patients will experience less medical errors, burnout and dissatisfaction – that is a fact.
I hope more healthcare organizations are waking up and realizing the importance of investing in the life and communication skills of physicians. Ignoring these topics is like ignoring a fast-spreading cancer.
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