Perspectives

Physician Well-Being and Medical Ethics

Authors: Ramin Walter Parsa-Parsi, MD, MPH

Abstract

Not many people would feel comfortable boarding an airplane knowing that the pilot at the controls had been working for 24 hours straight, without a break. Excessive working hours, sleep deprivation, and the resulting fatigue and exhaustion can increase the potential for human error.1 The link between excessive working hours and diminished ability is acknowledged by the aviation industry in that maximum working hours are strictly enforced for pilots in the interest of passenger safety. Physicians often are advised to learn from the aviation industry in their efforts to improve patient safety through the implementation of critical incident reporting systems, error management systems and safety checklists, to cite a few examples.2–4

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. West C, Tan AD, Habermann TM, et al. Association of resident fatigue and distress with perceived medical errors. JAMA 2009;302:1294–1300. 2. Kapur N, Parand A, Soukup T, et al. Aviation and healthcare: a comparative review with implications for patient safety. JRSM Open 2015;7:2054270415616548. 3. Hickey E, Halvorsen F, Laussen PC, et al. Chasing the 6-sigma: Drawing lessons from the cockpit culture. J Thorac Cardiovasc Surg 2018;155:690–696.e1. 4. Suliburk JW, Buck QM, Pirko CJ, et al. Analysis of human performance deficiencies associated with surgical adverse events. JAMA Netw Open 2019;2:e198067. 5. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012;172:1377–1385. 6. Panagioti M, Panagopoulou E, Bower P, et al. Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. JAMA Intern Med 2017;177:195–205. 7. Shanafelt TD, Dyrbye LN, West CP. Addressing physician burnout: the way forward. JAMA 2017;317:901–902. 8. Freudenberger HJ. Staff burn-out. J Soc Issues 1974;30:159–165. 9. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 3rd ed. Palo Alto, CA: Consulting Psychologists Press; 1996. 10. Shanafelt TD, Mungo M, Schmitgen J, et al. Longitudinal study evaluating the association between physician burnout and changes in professional work effort. Mayo Clin Proc 2016;91:422–431. 11. Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ 2008;336:488–491. 12. Dewa CS, Jacobs P, Thanh NX, et al. An estimate of the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada. BMC Health Serv Res 2014;14:254. 13. Soler JK, Yaman H, Esteva M, et al. Burnout in European family doctors: the EGPRN study. Fam Pract 2008;25:245–265. 14. Hoff T, Whitcomb WF, Nelson JR. Thriving and surviving in a new medical career: the case of hospitalist physicians. J Health Soc Behav 2002;43:72–91. 15. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet 2009;374:1714–1721. 16. Han S, Shanafelt TD, Sinsky CA, et al. Estimating the attributable cost of physician burnout in the United States. Ann Intern Med 2019;170:784–790. 17. Shanafelt TD, Bradley KA, Wipf JE, et al. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136:358–367. 18. West CP, Dyrbye LN, Sinsky C, et al. Resilience and burnout among physicians and the general US working population. JAMA Netw Open 2020;3:e209385. 19. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc 2015;90:1600–1613. 20. Editorial. Physician burnout: a global crisis. Lancet 2019;394:P93. 21. Rotenstein LS, Torre M, Ramos MA, et al. Prevalence of burnout among physicians: a systematic review. JAMA 2018;320:1131–1150. 22. Kumar S. Burnout and doctors: prevalence, prevention and intervention. Healthcare (Basel) 2016;4:37. 23. Al-Dubai SAR, Ganasegeran K, Perianayagam W, et al. Emotional burnout, perceived sources of job stress, professional fulfillment, and engagement among medical residents in Malaysia. ScientificWorldJournal 2013;137620. 24. Medscape national physician burnout, depression & suicide report 2019. https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression6011056. Accessed January 7, 2020. 25. del Carmen MG, Herman J, Rao S, et al. Trends and factors associated with physician burnout at a multispecialty academic faculty practice organization. JAMA Netw Open 2019;2:e190554. 26. Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020;3:e203976. 27. Li W, Frank E, Zhao Z, et al. Mental health of young physicians in China during the novel coronavirus disease 2019 outbreak. JAMA Netw Open 2020;3:e2010705. 28. Shanafelt TD, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA 2020;323:2133–2134. 29. Dzau VJ, Kirch D, Nasca T. Preventing a parallel pandemic—a national strategy to protect clinicians’ well-being. N Engl J Med 2020;383:513–515. 30. Marburger Bund. MB-Monitor 2017; https://www.marburger-bund.de/sites/default/files/files/2018-09/mb-monitor-2017-grafische-darstellung.pdf. Accessed January 6, 2020. 31. Sancar F. A cultural sea change: mindfulness for surgical residents. JAMA 2019;322:388–389. 32. World Medical Association. WMA statement on physicians well-being. https://www.wma.net/policies-post/wma-statement-on-physicians-wellbeing. Accessed January 7, 2020. 33. World Medical Association. WMA Declaration of Geneva. https://www.wma.net/policies-post/wma-declaration-of-geneva. Accessed January 7, 2020. 34. World Medical Association. WMA International Code of Medical Ethics. https://www.wma.net/policies-post/wma-international-code-of-medicalethics/medical-ethics. Accessed November 19, 2020.