KeyLIME Session 206:
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Panagioti, et al,. Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction A Systematic Review and Meta-analysis JAMA Intern Med. 2018;178(10):1317-1330.
Reviewer: Jason Frank (@drjfrank)
Concerns about physician burnout have reached a strident pitch, with evidence of high suicide rates, and even higher prevalence of doctors meeting criteria for pathologic job stress. A standard definition of burnout is “a response to prolonged occupational stress encompassing feelings of emotional exhaustion, depersonalization, and reduced professional efficacy”, classically measured by the Maslach Burnout Inventory (MBI).
Obviously, all of us in meded care about this topic. (In fact, we have discussed MD wellness and burnout in episodes #146, #130, & #103!) We are all trying to address physician wellness in our environments, and it is now an accreditation standard for medical education in many systems. But is this just a case of angst and ennui? Should the public care if we are stressed out?
The connections between physician burnout and patient care has been explored in several studies over the years. The authors of this study set out to conduct the definitive systematic review and meta-analysis.
The authors “examined whether physician burnout is associated with lower quality of patient care,” including 1) patient safety incidents, 2) suboptimal care outcomes, and 3) lower patient satisfaction.
Key Points on Method
This is a generally outstanding paper that is a model for systematic reviews & metas. The authors follow prescribed high quality methodologies, and conform to the MOOSE and PRSIMA guidelines. They carefully define their terms and search parameters. They operationalized their concept of professionalism using Stern’s 4 dimensions (excellence, accountability, altruism, and humanism).
They looked in the 4 top databases for papers with physicians, burnout, and patient care terms in any language. Papers were extracted, rated, and data on effect sizes determined.
Notably, this was a search for quantitative observational studies only. All gray literature was excluded.
The authors’ search initially found 5234 papers that addressed the topic. After screening, 47 studies were included, representing 42,473 physicians. Mean age was 38 years (range 27-53).
Physician burnout was associated with:
- an OR of 1.96 for patient safety incidents
- an OR of 2.31 for poorer quality of care
- and an OR of 2.28 for reduced patient satisfaction.
Heterogeneity of studies was high, and study quality was low. The results are at risk of recall bias, as most studies involved self-report of the patient outcomes.
Early career docs, once again, come up as the most at risk for burnout.
The authors conclude that physician burnout is both epidemic and significant. Physician burnout jeopardizes care and is a public health issue that needs to be addressed.
Spare Keys – other take home points for clinician educators
- This is a great role model paper for a good quality SR & meta.
- This is a landmark paper to quote the impact of physician burnout and it is a call to arms for all of us to build better meded & clinical workplaces.
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