Demystifying Mindfulness In Medicine: Part 5 of 12

Demystifying Mindfulness is your mini-crash course in mindfulness. I’ve gathered 12 real-life physician issues that contribute to stress, anxiety, frustration, anger, overwork, and overwhelm, and I’ve broken them down with real practices that cost you nothing but a little time and attention. Whether your challenges show up in your day-to-day work or you’re dealing with big-picture issues, you can build a practice in mindfulness to transform your work and your life and get back to the reason you’re doing what you do. This installment of Demystifying Mindfulness addresses the impact of physician burnout on medical error. Read on to find four tools for finally getting over your burnout and check out other posts in the series for more real questions and answers from one physician to another.

Today’s Topic: Medical Error And Physician burnout

We all know that there’s an epidemic of physician burnout. Many physicians spend hours on the computer after long days in the office, feeling drained and overwhelmed, losing any sense of meaning and purpose. And then there’s the spillover into family life. We can often be so consumed with our work that we’re unable to be present with loved ones. But the burnout epidemic is even more costly than this. In addition to the profound impact on quality of life at work and at home, there is increasing data showing that physician burnout correlates with increased incidence of medical errors.

In a recent study published in the Mayo Clinic Proceedings, a nationwide random sampling of 6,695 physicians in active practice completed the gold standard assessment of physician burnout, the Maslach Burnout Inventory (MBI). In this cohort, 54% were categorized as having burnout. 10.5% reported a self-perceived major medical error in the previous three months, largely error in judgment, making the wrong diagnosis, or a technical mistake. Most of these errors had no perceived effect on patient outcomes, but 5.3% resulted in “significant permanent morbidity” and 4.5% in patient death. The 691 physicians who reported errors had a higher prevalence of overall burnout than the 5,895 who did not report errors (77.6% vs. 51.5%).

The impact of burnout isn’t area-specific. After adjusting for specialty, work hours, fatigue, and work unit safety rating, physicians with burnout were found to have twice as much self-reported medical error. Other studies corroborate these findings. A meta-analysis and a systematic review also established a strong correlation between physician burnout and medical error.

These same systematic reviews have demonstrated that organizational interventions can reduce burnout, but what if your healthcare system hasn’t invested in addressing the burdens that impact physician burnout and patient safety? And, if your health system is not making this a top priority, where does that leave you?

It’s not just your patients’ safety but your own at stake. You may be aware of the term “second victims” regarding medical error:

“Fatal errors and those that cause harm are known to haunt healthcare practitioners throughout their lives. The impact of the errors is felt in their private lives, in interactions with professional colleagues, and in the context of their social lives.” (Grissinger)

The emotional impact of knowing that you contributed to patient harm can affect your health, well-being, and performance. If you want to feel more clear, present, and confident in your work—to feel as you did before burnout—self-awareness is a powerful tool you can begin working with today.

Self-awareness doesn’t require you to change the system, get a new job, or take a two-month vacation. You can start now by cultivating mindfulness. Consider what you’re already noticing in yourself. A key element of physician burnout is the depersonalization of patients—seeing them as objects rather than the whole human beings they are. When you’re struggling, do you put in less effort with your patients? It’s worth taking some time to make note of your burnout symptoms and consider how they show up in practice for you, whether that’s depersonalization, distraction, disinterest, a combination of these, or something more. With awareness, the cornerstone of mindfulness, these patterns can serve as early warning systems to help you realize how burnout may be putting you at risk. And just as with early warning signs in disease, not intervening can be costly.

 

Four Steps To Lower Your Risk of Medical Error

But just how can you affect change? Let’s come back to the concept of self-awareness—it’s important to know where your attention lies, how you’re showing up for your patients, and what your goals in your work as a physician really are. Giving attention to these questions is a practice in mindfulness. Here are four concrete steps you can work with to lower your risk for medical errors. I encourage you to take some time today and give these a try.

  1. Reconnect with why you went into medicine in the first place. If it was to take care of others, remind yourself to keep your eyes on this prize.
  1. Set a daily intention to be more present with each and every patient.
  1. Recognize and attend to your own suffering. Make space for this outside of the time you spend with patients. If you find yourself mentally railing against “the system,” use that moment to remind yourself that you’re doing the best you can. Acknowledge all the ways you’re working at maximum capacity. This may sound trivial, but this self-validation is key.
  1. Utilize any opportunity you can to voice your experience and concerns with your healthcare institution. Keep your emphasis on the shared goal of patient safety rather than your personal complaints.

It’s challenging when you have so many demands on your time, but give yourself a chance to change the patterns that aren’t working and bring vitality back to your practice and your life. Based on my work coaching hundreds of physicians, I think you’ll be pleasantly surprised at the impact a mindful approach can have. I’d love to hear about your experience.

To your resilience,

Gail Gazelle, MD