- The Washington Times - Tuesday, September 5, 2006

A new study says internal-medicine residents often make mistakes that can lead to depression, burnout and reduced empathy for patients — conditions that increase the likelihood of future medical errors.

This study suggests “that if a resident experiences more than stress — for example, conditions such as burnout and depression — the consequences on patients can be very significant,” said Dr. Tait D. Shanafelt, assistant professor of medicine at the Mayo Clinic and senior author of the report.

The authors of the study of first-year residents at the Mayo Clinic in Rochester, Minn., conclude that residency programs should try “to prevent, identify and treat burnout and to promote empathy and well-being for the welfare of [both] residents and patients.”

The study is in this week’s Journal of the American Medical Association, which includes separate studies that say most interns exceed work-hour limits and that on-the-job fatigue raises the risk of work-related injuries.

Nearly 15 percent of internal-medicine resident physicians at the Mayo Clinic report committing a medical error in the previous three months, and 34 percent acknowledge making at least one major error over a one-to-three-year period.

The “self-perceived error rates we found among residents at the Mayo Clinic were similar in frequency to those found in prior studies at prestigious institutions,” Dr. Shanafelt said.

Participants who believed they had made medical errors were three times more likely than others to test positive for depression. In addition, measurements indicating increased burnout and reduced empathy increased the odds of self-perceived error by a resident physician in the next three months.

A second report in the Sept. 6 issue of JAMA found that more than 80 percent of medical interns, or first-year residents, are exceeding work-hour limits imposed three years ago by the Accreditation Council for Graduate Medical Education.

In the year after the ACGME standards were implemented, more than two-thirds of interns said they exceeded the 30 consecutive-hours limit, and 43 percent reported working more than the maximum 80 hours weekly.

Nearly 44 percent said they did not get one day a week off, which is also required.

A third study found that such interns put themselves at increased risk for on-the-job fatigue and work-related injuries, such as cuts and needle sticks.

It found that 90 percent of needle-stick and laceration injuries reported by interns from 2002 to 2003 were caused by a lapse in concentration or fatigue. Such injuries, which can be dangerous if they involve transmission of blood-borne pathogens such as HIV or hepatitis, were more common during prolonged work periods, researchers said.

The Mayo study, also led by Dr. Colin P. West of the Mayo Clinic College of Medicine, analyzed data from 84 percent of eligible internal-medicine residents at the hospital between 2003 and 2006.

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