Does doctor burnout harm patients?

Hall and colleagues’ use of structured equation modelling¹ to study burnout increases our understanding of its origins but contributes less to our knowledge about its consequences. The problem is that patient safety — often said to be at risk when professionals are burnt out — was perceived by practitioners rather than measured independently. A systematic review and meta-analysis of mostly cross-sectional studies of low to moderate quality, and with a high level of heterogeneity,² showed that self-reported patient safety incidents were significantly associated with burnout symptoms, but the association between physician burnout and system-recorded safety incidents was not statistically significant. One possible explanation is that those with burnout are more self-critical, honest, and likely to report having made errors even when they had not. Lawson argues strongly that researchers, medical journals, and medical leaders should not infer that burnout is associated with, let alone a meaningful cause of, preventable adverse events.³ The interventionist view that too much is at stake and that urgent action is needed, even if knowledge is imperfect,⁴ is challenged by Schwenk and Gold, who argue that action is being proposed for a symptom without an understanding of its pathophysiology, origins, consequences, and effective treatments.⁵ As for urgent action, after nearly 50 years of study of burnout there are many proposed solutions to it but little evidence of their effectiveness. Further exploration is needed, but we should make haste slowly.