Burnout in doctors doubles chances of patient safety problems, study finds

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Doctors suffering from burnout are far more likely to be involved in incidents where patients’ safety is compromised, a global study has found.

Burned-out medics are also much more likely to consider quitting, regret choosing medicine as their career, be dissatisfied with their job and receive low satisfaction ratings from patients.

The findings, published in the British Medical Journal, have raised fresh concern over the welfare and pressures on doctors in the NHS, given the extensive evidence that many are experiencing stress and exhaustion due to overwork.

A joint team of British and Greek researchers analysed 170 previous observational studies of the links between burnout among doctors, their career engagement and quality of patient care. Those papers were based on the views and experience of 239,246 doctors in countries including the US, UK and others in Africa, Asia and elsewhere globally.

They found that burned-out medics were twice as likely as their peers to have been involved in patient safety incidents, to show low levels of professionalism and to have been rated poorly by patients for the quality of the care they have provided.

Doctors aged 20 to 30 and those working in A&E or intensive care were most likely to have burnout. It was defined as comprising emotional exhaustion, depersonalisation – a “negative, callous” detachment from their job – and a sense of reduced personal accomplishment.

Burnout is a huge problem among NHS doctors. The General Medical Council’s latest annual survey of the UK’s trainee doctors, published in July and based on responses from 67,000 medics, found that “the risk of burnout is now at its worst since it was first tracked in 2018” due to heavy workloads, which have been exacerbated by the Covid-19 pandemic.

Two-thirds of trainees told the medical regulator that they “always” or “often” feel worn out at the end of their working day, while 44% regularly felt “exhausted in the morning at the thought of another day at work”.

The BMJ paper says: “This systematic review and meta-analysis provides compelling evidence that physician burnout is strongly associated with the career disengagement of physicians and suboptimal patient care.”

In January, the Medical Defence Union, which represents doctors accused of wrongdoing, published survey findings showing that a large minority of doctors are sleep-deprived and that 26% of them said that tiredness had impaired their ability to provide safe care.

Dr Michael Farquhar, an expert in children’s sleeping problems at Guy’s and St Thomas’s NHS trust in London, said that sleep deprivation made doctors more likely to make mistakes such as wrongly calculating doses of medicine. They may also take longer to assess a patient’s symptoms and arrive at a diagnosis, he added.

Responding to the new findings in the BMJ, Dr Latifa Patel, the chair of the British Medical Association’s representative body, said: “This report will not be a surprise to doctors and medical students. Burnout is not just a question of personal wellbeing or career satisfaction – it is a matter of patient safety.

“Tired, undervalued and understrength doctors cannot work to the best of their abilities and these figures throw into disturbing relief what that means for patient care.

“The tragic consequences of burnout have their root in the workforce crisis, and if the NHS cannot recruit or retain its staff, the vicious cycle of poor patient care will only accelerate.”

Dr Rob Hendry, the medical director of the Medical Protection Society, another medical defence body, said: “When doctors are exhausted and burnt out, it is not only damaging for their personal wellbeing but also jeopardises patient care.

“If we don’t act now sadly many more passionate and committed doctors will become burnt 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.”

The Department of Health and Social Care said it had taken steps to improve patient safety. It has required all NHS trusts in England to tell patients if their safety has been compromised and apologise, given legal protection to whistleblowers, and appointed a “freedom to speak up guardian” in each trust with whom staff worried about safety issues are encouraged to raise concerns.