The study of more than 3,100 physicians in the United States and Canada examined the impact of errors on physicians, which physicians are most affected, and how physicians could be better supported after errors occur. Ninety-two percent of the surveyed physicians had been involved with a near miss, or a minor or serious error.

The study-"The Emotional Impact of Medical Errors on Practicing Physicians in the United States and Canada"-is the first large study of its kind to demonstrate that physicians can also be negatively affected by medical errors. Approximately half of the physicians surveyed reported that their involvement in medical errors increased their job-related stress. One in three physicians involved only with near misses also reported that their lives were negatively affected, indicating that physician distress after errors is not limited to the occurrence of serious errors. However, the greater the severity of the error, the more likely it was that the physician would be affected.

Although more than 80 percent of physicians expressed interest in counseling after serious errors, many also agreed that a variety of barriers might prevent them from seeking it out. The authors of the study, led by Amy Waterman, Ph.D., at Washington University in St. Louis, Missouri, and her colleagues at the university and elsewhere, note that hospitals and other health care organizations should consider broadening the array of formal and informal sources of error-related support available to physicians during and after work hours.

"Everyone involved with a medical error-the involved patient, the patient's family, and the physicians and health care team providing care-is affected by it," says Amy Waterman, Ph.D., psychologist and assistant professor of medicine, Washington University School of Medicine. "Counseling needs to be made available to patients and health care professionals so that everyone involved with errors receives the support they need."

Other notable findings in the study include:

• Physicians reported increased anxiety about future errors (61 percent), loss of confidence (44 percent), sleeping difficulties (42 percent), reduced job satisfaction (42 percent), and harm to their reputation (13 percent) following errors.
• Physicians were more likely to report that their job-related stress increased when they had been involved with a serious error. However, one-third of physicians only involved with near misses also reported increased stress.
• Physicians were more likely to be distressed after serious errors when they were dissatisfied with how error disclosure to patients went.
• Only 18 percent of physicians had received education or training in disclosure of errors, and 86 percent expressed interest in such education or training.
• Only 10 percent of physicians surveyed agreed that health care organizations adequately supported them in coping with error-related stress.
• More than one-third of physicians felt that taking time away from work for counseling was difficult (43 percent), did not believe that counseling would be helpful (35 percent), were concerned that what was said in a counseling session would not be kept confidential if they were sued (35 percent), and were concerned that their counseling history would be placed in their permanent record (34 percent).
• In addition, 23 percent of physicians were concerned that receiving counseling could affect their malpractice insurance costs, and 18 percent were concerned that they would be judged negatively by their colleagues for receiving counseling.

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