• Tait D Shanafelt, Charles M Balch, Gerald Bechamps, Tom Russell, Lotte Dyrbye, Daniel Satele, Paul Collicott, Paul J Novotny, Jeff Sloan, and Julie Freischlag.
• Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA. shanafelt.tait@mayo.edu
• Ann. Surg. 2010 Jun 1; 251 (6): 995-1000.

ObjectiveTo evaluate the relationship between burnout and perceived major medical errors among American surgeons.BackgroundDespite efforts to improve patient safety, medical errors by physicians remain a common cause of morbidity and mortality.MethodsMembers of the American College of Surgeons were sent an anonymous, cross-sectional survey in June 2008. The survey included self-assessment of major medical errors, a validated depression screening tool, and standardized assessments of burnout and quality of life (QOL).ResultsOf 7905 participating surgeons, 700 (8.9%) reported concern they had made a major medical error in the last 3 months. Over 70% of surgeons attributed the error to individual rather than system level factors. Reporting an error during the last 3 months had a large, statistically significant adverse relationship with mental QOL, all 3 domains of burnout (emotional exhaustion, depersonalization, and personal accomplishment) and symptoms of depression. Each one point increase in depersonalization (scale range, 0-33) was associated with an 11% increase in the likelihood of reporting an error while each one point increase in emotional exhaustion (scale range, 0-54) was associated with a 5% increase. Burnout and depression remained independent predictors of reporting a recent major medical error on multivariate analysis that controlled for other personal and professional factors. The frequency of overnight call, practice setting, method of compensation, and number of hours worked were not associated with errors on multivariate analysis.ConclusionsMajor medical errors reported by surgeons are strongly related to a surgeon's degree of burnout and their mental QOL. Studies are needed to determine how to reduce surgeon distress and how to support surgeons when medical errors occur.

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