The British Medical Journal is highlighting this month an article by Fahrenkopf et al entitled “Rates of medication errors among depressed and burnt out residents: prospective cohort study“. When I read the title of this research article my first thought was here’s another “Duh study”; I mean wouldn’t you expect depressed and burned out doctors to make more errors?
But useless and uninteresting research rarely makes it past the attentive and demanding eye of this Granddaddy of medical journals and the article was indeed not without surprise.
To summarize, this prospective cohort study enrolled 123 residents across three American paediatric wards, assuring the necessary anonymity and patient/participant safety, in order to study the number of medication errors per resident month. Using well-established questionnaires, the residents were organized into four non mutually exclusive mental health states: depressed, not depressed, burned out, not burned out. Their medication errors were then monitored and classified into four clearly defined groups, ranging from the least serious: “errors with little potential for harm” to the most serious: “preventable adverse events” (luckily there were none of the latter).
The results after statistical analysis indicated that indeed the 20% of residents described as depressed made more medical errors than non-depressed confrères, and not just a few; they made over six times as many errors, and this impressive number stayed high even after correcting for outliers.
Interestingly however, those who were described as “burned out” (75%) did not make more errors than their peers, despite the fact that the self-reported errors more frequently than those who were not burned out.
There were several statistical and interpretational concerns that the authors address in the article, but although relatively small in number, this study raises numerous questions on the effect of the intensity of resident training on patient safety and the safety of the residents themselves. I understood from the article that between the time of data collection and publication of the article, some work-time limits had been imposed in the hospital systems, but the effect that these reduced hours may have remain unclear. The authors did cite other articles suggesting that reduced work load may have a positive effect on burn out, but not depression, and since it was depression that lead to medication errors…
Now of course we have all the usual caveats: it’s a relatively small study group and the results will need further validation; the study was carried out in pediatrics wards and whether or not extrapolation to other specialties is possible is unknown; the study was done on the very special case of medical residents; etc. Nevertheless, this article is a good reminder that doctors are humans and are thus susceptible to human frailties, like you and me.
I do believe that learning specialists (and all medical professionals) must be pushed very hard; I think it’s a good way to separate the wheat from the chaff and chase off those who want to become doctors for the money. But if they’re being pushed so hard that they’re become depressed (often without realizing it according to the article) and possibly putting their patients health at risk, well, maybe it’d be a good idea to back off a bit.