How to Prevent Medical Error Causes and Physician Burnout

by | Oct 24, 2018 | Physician Burnout, Physician Mindfulness

A Mindfulness In Medicine Series: A 12-Part Series

Demystifying Mindfulness is your mini-crash course in mindfulness. In this post we look at medical error causes. 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 the consequences of 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: Physician Burnout And How To Prevent Medical Error Causes

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. I will tell you how to prevent medical error.

Some Medical Error Statistics

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%).

Why Do Medical Errors Occur

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 causes.

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 health care 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.

Using Mindfulness To Prevent The Risk Of Medical Errors

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.

But just how can you effect 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

  1. Embrace uncertainty

When you stop and think about it, uncertainty and change are the only things that are certain. Impermanence is one of the basic laws of our world.

After all, everything changes. Our relationships change. Our kids grow up and change. Our bodies age and change. Our environments change. Our planet changes.

All too often, however, we forget this basic truth. We somehow expect things to be predictable and stable.

The problem is that this expectation sets us up for difficulty. It leaves us struggling unnecessarily when something shifts. It adds a layer of suffering above and beyond that caused by all the VUCA around us.

What I’m getting at is that we have a choice. We can meet uncertainty with reactivity or we can meet it with mindful understanding.

More than meditating on a remote mountainside, mindfulness helps us have the calm, steadiness, and clarity we need to work constructively with all the change and uncertainty.

At the same time, while we can find ourselves resisting change, we can remind ourselves that it does not have to mean something bad! Just take a moment right now to think of all the difficulties you have faced in your life and work that are now resolved and far behind you. This can help you see how change has actually been quite the positive.

  1. Respond to complexity with compassion

Even knowing that change is the only thing that is certain, it can still be difficult to weather. Living in such a VUCA time is difficult. You deserve compassion for managing all the challenges.

With mindful awareness, we can bring ourselves compassion for what we’re going through. There is increasing evidence that self-compassion is a powerful antidote to stress and even burnout. From where I sit, I think that it is actually one of the most powerful medicinals available to us.

  1. Take purposeful pauses

With mindfulness, we are aware of what is going on within and around us. We tune in and pay attention to our experience. We learn to utilize our breath to take us out of the fears, worries, stories, and preoccupations our minds are so good at generating about what might come next, and bring us back to the present moment. Here in the present, we leave that overly activated limbic state and can experience a sense of calm.

A pause also serves to allow our prefrontal cortex to come online. It creates a critically important space between our emotional response and conscious, intentional action.

Once we have paused, we can then see more clearly that fear had taken hold. 

With a pause, we become the witness of our experience as opposed to the one trapped by it.

  1. View VUCA as opportunity

I don’t know about you, but I can find myself reacting to the VUCA environment with something of a fixed mindset. With a fixed mindset, I am telling myself things like ‘it shouldn’t be this way’ and ‘why is this happening?’

When I can utilize mindful awareness, I can see that I’ve boxed myself in with a fixed mindset. I can challenge myself to grow. By grow, I mean challenging myself to see whatever difficulty I’m experiencing as an opportunity to learn.

Here again, mindfulness again throws us a lifeline. Mindful awareness involves leaning into curiosity.

I can flip the script and ask myself:

What can I learn from this experience?

How can I use this to be a better version of myself?

How can I help others cope in this VUCA environment?

What do I want to look back and see about how I acted?

In summary, while VUCA is definitely the order of the day in healthcare and beyond, you don’t have to succumb. You don’t have to live in fear. There are constructive actions you can take to help you cope with uncertainty, build calm in chaos, and even thrive in chaos and VUCA. While we can’t control much that is contributing to the VUCA time, with mindfulness we can control how we respond to it.

I hope you’ll try out these 4 mindfulness strategies as I have seen them help countless people. I’d love to hear how it goes.

_____

To learn more about how mindfulness coaching can help you cope with this VUCA time, please reach out for a complimentary consult.

6 Free Resources To Help You During COVID19 And Beyond.

  1. 14-day meditation series 
  2. Imposter No More PDF
  3. Resilience Book Chapter
  4. Leading In Crisis PDF
  5. Balance To Burnout PDF
  6. 30-minute consult

Take advantage of one or more of these valuable resources created for clinicians and non-clinicians.