Burned-out doctors twice as likely to be involved in patient safety incidents

Doctors with burnout are twice as likely to be involved in patient safety incidents such as medication errors, a large study has found.

The meta-analysis published in the BMJ today of 170 studies across the world found that the link between burnout and medication errors was greatest in doctors aged 20-30 years and lowest in GPs.

It also found that GPs suffered the lowest levels of burnout, but GP leaders pointed out this was potentially because the analysis included only four studies from the UK.

However, they added that the link between burnout and patient errors has implications for UK GPs.

Calls to the BMA’s mental health counselling service sky-rocketed over the summer, with GPs making almost two-thirds of calls, and other studies in the UK have shown that GPs are the doctor group most likely to face burnout, with the GMC recently saying that GPs are ‘reporting much greater pressure than any other group’.

The analysis of 170 observational studies of 239,246 physicians conducted between the start of relevant databases and May 2021 looked at links between physician burnout, career engagement and the quality of care provided to patients.

The data showed that:

• Burnout in physicians was associated with an almost four times decrease in job satisfaction
• In the presence of increased burnout, career choice regret increased more than threefold
• Burnout was associated with small but significant decreases in productivity
• As burnout increased, low professionalism was twice as likely, as was patient dissatisfaction
• Burnout and poorer job satisfaction were greatest in hospital settings, physicians aged 31-50 years and those working in emergency medicine and intensive care, while it was lowest in GPs.

The researchers said their meta-analysis ‘provides compelling evidence that physician burnout is associated with poor function and sustainability of healthcare organisations primarily by contributing to the career disengagement and turnover of physicians and secondarily by reducing the quality of patient care’.

They added: ‘Healthcare organisations should invest more time and effort in implementing evidence-based strategies to mitigate physician burnout across specialties, and particularly in emergency medicine and for physicians in training or residency’.

Writing in the BMJ in a linked editorial, professor of patient safety at the University of Bonn Professor Matthias Weigl said that the research adds to ‘growing evidence that the poor mental health of healthcare providers jeopardises the quality and the safety of patient care’.

GP Survival chair Dr John Hughes said: ‘Only four (2%) of the 170 articles reviewed were from the UK and I believe the experience of UK GPs, particularly in recent years, is very different to that of GP colleagues elsewhere, with the exponentially increasing workload, patient demand and the total lack of recognition of this from NHSE or Government, plus the persistent press denigration of GPs, contributing to a dramatic increase in burnout and an exodus from the profession: both of these are obviously significant risks to good patient care.’

Dr Hughes added that he was ‘unsurprised’ by the study’s results in general and felt they are ‘a message that employers including NHSE need to take extremely seriously’.

He said: ‘GP Survival would urge the Government, NHSE and patient groups to take serious note of this study, while recognising its limitations and that the situation for UK GPs is actually much worse, and take urgent action to reduce burnout in GPs and maintain patient safety and good care.

‘Urging staff to be “resilient” and sending messages urging wellbeing activities to an overworked and overwhelmed profession are not solutions.’

Doctors’ Association UK (DAUK) co-chair Dr Matt Kneale told Pulse: ‘With chronic underfunding and decreasing staffing across the board, on the background of a major pandemic, it is no wonder that doctors are facing burnout at unprecedented levels. This is a national health crisis and without being addressed, staffing levels will continue to decline and patient safety will be compromised. 

‘We recognise the BMJ survey but suggest it is likely an underestimate of the true burden of burnout, given that even “minor” burnout not described in the headline findings is too much. This is reflected by GPs showing the lowest levels of burnout and yet still nationally declining in number.’ 

Medical Protection Society (MPS) medical director Dr Rob Hendry said the review ‘corroborates’ its own concerns.

He said: ‘When doctors are exhausted and burned out, it is not only damaging for their personal wellbeing but also jeopardises patient care. There are multiple, complex factors contributing to the situation.’

We must gain a deeper understanding of burnout causes in doctors, he said, as well as make sure there are appropriate support structures as well as longer-term strategies for more sustainable working environments.

He added: ‘If we don’t act now, sadly many more passionate and committed doctors will become burned out and disillusioned. Others will choose to leave the medical profession, resulting in a loss of expertise for patients and even more pressure on stretched resources.’

Meanwhile, a patient safety watchdog will be given new and expanded powers to investigate incidents that take place in GP practices from 2023 under the new Health and Care Bill.