Depressed Trainee Doctors Make More Medication Errors Than Non-Depressed Colleagues

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Main Category: Medical Students / Training
Also Included In: Depression;  Anxiety / Stress;  Mental Health
Article Date: 12 Feb 2008 - 0:00 PDT

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In a recent US study published in the British BMJ and available on bmj.com, researchers found that depressed doctors in training are more than six times as likely to make medication errors as their non-depressed colleagues.

Studies have shown that doctors in training, or residents, are highly likely to develop depression and burnout. Burnout is "a syndrome of mental exhaustion and personal detachment that develops in response to occupational stress," the authors clarify. Rates of burnout in residents are between 41% and 76%, while rates of depression range from 7% to 56%.

In the US and the UK, medication errors are also quite common. Up to 98,000 patients die each year in the US due to medication errors. In the UK, adverse events - or injuries due to medical management - occur in more than 10% of hospital admissions; half of these may be preventable.

While in training, resident physicians often experience heightened stress - most commonly in the forms of sleep deprivation and a lack of leisure time. There is scarce research that quantifies the relationship between stress and patient safety.

Researchers, led by Amy Fahrenkopf of the Harvard Medical School, analyzed 123 pediatric residents at three children's hospitals in the US to determine the prevalence of depression and burnout. They also sought to establish if a relationship exists between these disorders and medication errors - any harmful of trivial error in the ordering, transcription, or administration of a medication.

Initial survey data that was analyzed according to standardized criteria revealed that one in five (20%) of the participating residents were depressed and almost three quarters (74%) were burned out. During the survey period, 45 medication errors were made by participants.

Two key findings are reported: 1) Depressed residents made 6.2 times as many medication errors as their non-depressed colleagues. 2) Burnout did not appear to be linked with higher rates of medication errors.

The authors state that their findings "indicate that mental health may be a more important contributor to patient safety than previously suspected." They also draw attention to the high burnout rate in this study, which is similar to what is found in other studies. This raises questions about "whether current methods of doctors' training generate avoidable stress that is detrimental to the health of residents."

The authors note that since collecting data for this study, the US has implemented work hour limits for resident physicians. However, studies suggest that work hour changes did not alter rates for depression but have significantly decreased burnout scores.

"Our results highlight the need for better research on the mental health of doctors," conclude the authors." Further efforts to study and improve the working conditions and mental health of doctors should be a priority, they conclude."

An accompanying editorial warns that although it is possible that depression and burnout are associated with medication errors, the results of Fahrenkopf and colleagues' research are far from conclusive. They state a need for large, prospective, and appropriately designed studies in order to clarify roles of different factors involved in error generation.

Rates of medication errors among depressed and burned out residents: a prospective cohort study
Amy M Fahrenkopf, Theodore C Sectish, Laura K Barger, Paul J Sharek, Daniel Lewin, Vincent W Chiang, Sarah Edwards, Bernhard LWiedermann, Christopher P Landrigan
BMJ, February 7, 2008
doi:10.1136/bmj.39469.763218.BE
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Written by: Peter M Crosta
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