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As the prevalence of physician burnout rises, so too might the occurrence of medical errors. A recent 

 by researchers at Stanford University School of Medicine found that physicians with burnout were more than twice as likely to commit medical errors, even after adjusting for specialty, work hours, fatigue, and workplace safety. 

But the relationship between physician burnout and medical errors may be more cyclical than linear. “We value our relationships [with patients], so when someone dies or an error occurs … not only does it hurt the patient and the family, but we are upset as well,” says Tracey L. Henry, MD, MPH, FACP, assistant professor of medicine at Emory University in Atlanta. When left unaddressed, this emotional or psychological stress can further contribute to burnout.

Despite this issue, Henry says most institutions do not have a system in place to support physicians and other healthcare professionals in the event of a medical error or adverse patient outcome. As a result, many physicians avoid disclosing errors and end up internalizing their emotions because “there’s this machismo culture in medicine, and so a lot of times we are ashamed to ask for help,” she explains, noting that early career physicians tend to struggle the most with error-related stress because their clinical self-confidence is still developing.

At this year’s ACP Internal Medicine Meeting in Philadelphia, Henry will moderate an interactive panel discussion focused on helping physicians recover and grow from medical errors. The panelists will use programs currently in place, such as 

, to provide physicians with resources and best practices for coping with medical errors that they can take back to their organization or practice. 

Specifically, leaders should create awareness that medical errors happen and can happen to any physician, and then ensure that physicians are able to process their emotions in a healthy way. Henry recommends developing a protocol that includes nonpunitive teams debriefs following an error or adverse event and a peer-to-peer support network. She notes that it’s important for the individuals leading the debriefs and peer support groups to receive training in order to ensure they understand how to discuss the error without pointing blame or re-traumatizing the physician.  

“We’re all human. Everyone makes medical errors at some point in their career,” Henry says. “This is how you deal with it. This is how you move forward.”

Henry’s ACP 2019 session, “Medical Errors and How to Grow From Them,” will take place on Saturday, April 13 at 11:15 a.m.

Articles

Join ACP and your colleagues in New Orleans at the annual marquee educational event for internal medicine physicians and subspecialists around the globe. Together physicians will share in three days of unparalleled professional revitalization and learning within the internal medicine community.

When medical errors occur, patients suffer-but so do physicians.

ACP 2019: Caring for the caregiver after a medical error

Doctors have long known that patients’ health depends as much on life circumstances, such as being able to afford healthy food and decent housing, as any treatments doctors themselves can provide. Even so, many physicians are, for a variety of reasons, reluctant to ask patients whether they face such challenges in their lives. 

But that situation may be changing, thanks to a growing focus on the importance of social determinants of health (SDOH) says Elaine Waxman, PhD, a senior fellow at the Urban Institute, a Washington, D.C.-based think tank, and former vice president for nutrition issues at Feeding America, a nationwide network of food banks.

Waxman is among a panel of experts who will discuss ways doctors and healthcare policymakers can address SDOH at the 2019 ACP Internal Medicine Meeting in Philadelphia.

Waxman notes that among the challenges to incorporating SDOH into medical care is recognizing when it is an issue, then knowing how to discuss it with patients. “Most doctors don’t mean to be insensitive to the challenges their patients face, they just don’t understand the extent of them because they haven’t experienced significant hardship in their own lives,” she says. 

Moreover, it can be difficult to identify patients experiencing SDOH-related health issues by outward appearances alone. “When we see a homeless person we make assumptions about how they’re doing. But if someone has housing and is working, even if it’s a low-wage job, it’s easy to think things are better for that person than they really are.”

The solution, Waxman says, is for doctors to routinely screen for SDOH issues such as food insecurity, and get trained in how to talk about them so they feel less awkward in doing so. “Give them resources they can tap to address issues they may feel are outside their wheelhouse,” she says. 

Similarly, doctors need information on how to help patients deal with the high cost of many prescription medications, another important SDOH, either through programs that can make the drugs more affordable, or managing the patient’s disease around the problems resulting from low incomes.

She cites the example of diabetic patients who skip meals at the end of the month when their Supplemental Nutrition Assistance Program (SNAP) benefits run out, but continue taking insulin, thereby risking hypoglycemia. “Some physicians will tell their patients, ‘if you know you can’t eat, that’s a time not to take that medication,’” she says. “It’s a matter of partnering with patients to address these problems, instead of patients feeling they have to manage on their own.”

When it comes to advocating for policy changes that can improve health-another topic the panel will discuss-Waxman says physicians can, and should, make their voices heard among elected officials and other policymakers. 

“Doctors can speak up on issues where they feel comfortable, like helping policymakers understand that adequate food is a type of medicine or that poor-quality housing has a direct health impact,” she says. She points out that it was a physician who discovered and publicized the elevated lead levels in Flint, Michigan’s drinking water. “That proves physicians can make a huge difference in elevating the importance of a public health issue to a community,” she says.

Doctors around the country are starting to understand they need to think of themselves as just one part of a community-wide care team, Waxman adds. “You can’t just refer a patient out and hope that works,” she says. “If you really want to make headway in health improvements you’ve got to be actively engaged.” 

This ACP 2019 panel, “Improving Individual and Community Health,” will take place on Friday, April 12 at 4:30 p.m.

Doctors understand that social determinants of health have a major impact on patients' wellbeing, yet they often are reluctant to address such issues with their patients.

ACP 2019: Panel looks at how doctors can address social determinants of health

When Matthew Taylor, MD, PhD, began the process of choosing a medical specialty, he made a list of the disciplines he thought would evolve significantly during his career. Of the various areas he considered, the one he kept coming back to was genetics. 

Clearly, he was right. The breadth of genetic knowledge and its applicability to patient care is expanding rapidly. “We have many, many more [genetic] tests, and often those tests lead to confirming a diagnosis, providing some prognostic information, accessing a clinical trial, and in some cases, actually accessing some disease-specific therapies,” says Taylor, who is double boarded in internal medicine and clinical genetics and is the director of the adult medical genetics program at the University of Colorado Denver. 

Patients’ interest in their genetic information has increased as well, and the growth of the direct-to-consumer genetic test industry means a physician is no longer required. Patients do, however, expect their physicians to help interpret the results and determine appropriate treatment.  

The problem is that there are far too few geneticists to meet this demand, which means that primary care physicians must be prepared to integrate genetics and genomics into their daily practice. But many primary care physicians are not fully confident in their abilities to have genetic conversations with their patients, Taylor says.

“It’s quite frequent for us to see patients come in who have read a lot about what has been suggested they have, and they want to talk about what their mutation will or won’t be,” he says. “That can be daunting for the physician who realizes that the patient may know more about [a genetic condition] than they do, and you can’t always assess whether the patient has it right or not when you don’t really know what they’re talking about.”

At this year’s ACP Internal Medicine Meeting in Philadelphia, Taylor will lead a session focused on what internists need to know about genetics. 

He acknowledges that genetic diseases tend to be rare and unfamiliar to internists, so it’s difficult to have a comprehensive discussion about genetics without a disconnect from clinical practice. However, he will cover areas that most internists should expect to encounter, including what to do if a patient requests interpretation of genetic test results, how to determine if a patient might have a condition for which genetic testing is available, and how to assess if testing would have any utility for a patient and/or the patient’s relatives. 

Beyond attending this session, practicing internists looking to strengthen their competency in genetics may have to turn to a self-study approach, unless they want to go back to medical school. Taylor recommends guiding CME to focus more on genetics, attending genetics conferences, and reading the literature. 

And while it’s understandably difficult for internists in busy practices to devote additional time to learning more about genetics, Taylor believes it’s imperative. “If you’re an internist who is looking at retirement in the next couple of years, no problem. But if you’re just starting out or you’re in the midst of it … genetic and genomic medicine has arrived,” Taylor says. “And internists have a really critical role to play.” 

Taylor’s ACP 2019 session, “Genetics: What the Internist Needs to Know,” will take place on Thursday, April 11 at 7:00 a.m.

Internists have a major role in helping patients understand and manage their genetic conditions.

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