Hope modifies the association between burnout and self-perceived medical errors among practising physicians: implications for person-centered medicine

Main Article Content

Yasuaki Hayashino
Makiko Ozaki
Shunichi Fukuhara


Rationale, aims and objectives: Hope is an important resource that influences an individual’s ability to cope with stressful situations. The objective of this study is to evaluate the association of medical errors with burnout and hope among practising physicians using validated metrics.Method: Participants were physicians who had already completed residency training and were working in hospital settings (N=1054). Surveys included self-assessment of medical errors and validated Burnout Scale (depersonalization [DP] and emotional exhaustion [EE]) and Herth Hope Index. Frequency of self-perceived medical errors was recorded as the principal outcome measure.Results: A total of 716 errors were reported in 1054 physician-years. We observed a significant association between the burnout EE, DP domain score and reporting an error; compared with the lowest tertile category, IRRs of self-perceived medical errors of physicians in the highest category were 1.40 (95%CI, 1.16–1.68) and 1.37 (95%CI, 1.15–1.63) respectively, for EE and DP. We did not find a significant association between the hope score and self-perceived medical errors. In stratified analysis by hope score, among physicians with a low hope score, those who experienced higher burnout reported higher incidence of errors; physicians with high hope scores did not report high incidences of errors, even if they experienced high burnout.Conclusions: Self-perceived medical errors exhibited a strong association with physicians’ personal wellbeing: burnout was strongly associated with self-perceived errors. However, this association was modified when physicians felt hope. These results have immediate implications for the practice of person-centered medicine. In order to practise PCM effectively, the health of the person of the doctor is as important as the health of the person of the patient.

Article Details

Regular Articles


. Kohn, L.T., Corrigan, J.M. & Donaldson, M.S. (1999). To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press.

. Leape, L.L., Brennan, T.A., Laird, N., Lawthers, A.G., Localio, A.R., Barnes, B.A., Hebert, L., Newhouse, J.P., Weiler, P.C. & Hiatt, H. (1991). The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. New England Journal of Medicine 324 (6), 377-384.

. Baker, G.R., Norton, P.G., Flintoft, V., Blais, R., Brown, A., Cox, J., Etchells, E., Ghali, W.A., Hebert, P., Majumar, S.R., O’Beirne, M., Palacios-Derflingher, L., Reid, R.J., Sheps, S. & Tamblyn, R. (2004). The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. Canadian Medical Association Journal 170 (11), 1678-1686.

. Zhan, C. & Miller, M.R. (2003). Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. Journal of the American Medical Association 290 (14), 1868-1874.

. Rothschild, J.M., Landrigan, C.P., Cronin, J.W., Kaushal, R., Lockley, S.W., Burdick, E., Stone, P.H., Lilly, C.M., Katz, J.T., Czeisler, C.A. & Bates, D.W. (2005). The Critical Care Safety Study: The incidence and nature of adverse events and serious medical errors in intensive care. Critical Care Medicine 33 (8), 1694-1700.

. Kalish, R,L,, Daley, J., Duncan, C.C., Davis, R.B., Coffman, G.A. & Iezzoni, L.I. (1995). Costs of potential complications of care for major surgery patients. American Journal of Medical Quality 10 (1), 48-54.

. Classen, D.C., Pestotnik, S.L., Evans, R.S., Lloyd, J.F. & Burke, J.P. (1997). Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. Journal of the American Medical Association 277 (4), 301-306.

. Bates, D.W., Spell, N., Cullen, D.J., Burdick, E., Laird, N., Petersen, L.A., Small, S.D., Sweitzer, B.J. & Leape, L.L. (1997). The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. Journal of the American Medical Association 277 (4), 307-311.

. West, C.P., Tan, A.D., Habermann, T.M., Sloan, J.A. & Shanafelt, T.D. (2009). Association of resident fatigue and distress with perceived medical errors. Journal of the American Medical Association 302 (12), 1294-1300.

. West, C.P., Huschka, M.M., Novotny, P.J., Sloan, J.A., Kolars, J.C., Habermann, T.M. & Shanafelt, T.D. (2006). Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. Journal of the American Medical Association 296 (9), 1071-1078.

. Fahrenkopf, A.M., Sectish, T.C., Barger, L.K., Sharek, P.J., Lewin, D., Chiang, V.W., Edwards, S., Wiedermann, B.L. & Landrigan, C.P. (2008). Rates of medication errors among depressed and burnt out residents: prospective cohort study. British Medical Journal 336 (7642), 488-491.

. Lynch, W. (1974). Images of Hope: Imagination as Healer of the Hopeless. London, UK: University of Notre Dame Press.

. Dufault, K. & Martocchio, B.C. (1985). Symposium on compassionate care and the dying experience. Hope: its spheres and dimensions. Nursing Clinics of North America 20 (2), 379-391.

. Chi, G.C. (2007). The role of hope in patients with cancer. Oncology Nursing Forum. 34 (2), 415-424.

. McClement, S.E. & Chochinov, H.M. (2008). Hope in advanced cancer patients. European Journal of Cancer 44 (8), 1169-1174.

. Sand, L., Olsson, M. & Strang, P. (2009). Coping strategies in the presence of one's own impending death from cancer. Journal of Pain and Symptom Management 37 (1), 13-22.

. Thomas, N.K. (2004). Resident burnout. Journal of the American Medical Association 292 (23), 2880-2889.

. Tao, M. & Kubo, M. (1996). Theory and Researches of Burnout. Tokyo: Seishin Shobo.

. Kataoka, M., Ozawa, K., Ichie, K. & Iwamitsu, Y. (2008). The relationship between burnout, individual parameters, teaching aptitude and job satisfaction among research associates in colleges of nursing. Japanese Society of Nursing Research 31, 67-74.

. Kubo, M. (2004). Psychology of Burnout. Tokyo: Saiensu sha.

. Kubo, M. (2007). The Factorial and Construct Validity of the Japanese Burnout Scale. The Journal of Science of Labor 83, 39-53.

. Matsuda, S. (1997). The validity Japanese-translated Maslach Burnout Inventory. The Japanese Journal of Health Psychology 10, 44-53.

. Ueno, T. & Yamamoto, Y. (1996). The preventive effects of social support on burnout among nurses: the relations between burnout and the number of social supports, satisfaction with supports and support resources. The Japanese Journal of Health Psychology 9, 9-20.

. Moller Leimkuhler, A.M., Heller, J. & Paulus, N.C. (2007). Subjective well-being and 'male depression' in male adolescents. Journal of Affective Disorders 98 (1-2), 65-72.

. Henkel, V., Mergl, R., Kohnen, R., Allgaier, A.K., Moller, H.J. & Hegerl, U. (2004). Use of brief depression screening tools in primary care: consideration of heterogeneity in performance in different patient groups. General Hospital Psychiatry 26 (3),190-198.

. Henkel, V., Mergl, R., Kohnen, R., Maier, W., Moller, H.J. & Hegerl, U. (2003). Identifying depression in primary care: a comparison of different methods in a prospective cohort study. British Medical Journal 326 (7382), 200-201.

. Awata, S., Bech, P., Yoshida, S., Hirai, M., Suzuki, S., Yamashita, M., Ohara, A., Hinokio, Y., Matsuoka, H. & Oka, Y. (2007). Reliability and validity of the Japanese version of the World Health Organization-Five Well-Being Index in the context of detecting depression in diabetic patients. Psychiatry and Clinical Neurosciences 61 (1), 112-119.

. Bech, P., Olsen, L.R., Kjoller, M. & Rasmussen, N.K. (2003). Measuring well-being rather than the absence of distress symptoms: a comparison of the SF-36 Mental Health subscale and the WHO-Five Well-Being Scale. International Journal of Methods in Psychiatric Research 12 (2), 85-91.

. Herth, K. (1991). Development and refinement of an instrument to measure hope. Scholarly Inquiry for Nursing Practice. 5 (1), 39-51.

. Herth, K. (1992). Abbreviated instrument to measure hope: development and psychometric evaluation. Journal of Advanced Nursing 17 (10), 1251-1259.

. Chen, M.L. (2003). Pain and hope in patients with cancer: a role for cognition. Cancer Nursing 26 (1), 61-67.

. Lin, C.C., Lai, Y.L. & Ward, S.E. (2003). Effect of cancer pain on performance status, mood states, and level of hope among Taiwanese cancer patients. Journal of Pain and Symptom Management 25 (1), 29-37.

. Wonghongkul, T., Moore, S.M., Musil, C., Schneider, S. & Deimling, G. (2000). The influence of uncertainty in illness, stress appraisal, and hope on coping in survivors of breast cancer. Cancer Nursing 23 (6), 422-429.

. Koizumi, M., Ito, M. & Miyamoto, M. (1999). Hope in youth nursing students and older adults. Annals of Gunma University School of Health Sciences 20, 103-112.

. Kleinbaum, D.G., Kupper, L.L. & Muller, K.E. (1988). Applied Regression Analysis and Other Multivariable Methods. Boston, MA: PWS-Kent Pub. Co.

. Mitsumoto, H, & Rabkin, J.G. (2007). Palliative care for patients with amyotrophic lateral sclerosis: "prepare for the worst and hope for the best". Journal of the American Medical Association 298 (2), 207-216.

. Davison, S.N. & Simpson, C. (2006). Hope and advance care planning in patients with end stage renal disease: qualitative interview study. British Medical Journal 333 (7574), 886.

. Apatira, L., Boyd, E.A., Malvar, G., Evans, L.R., Luce, J.M., Lo, B. & White, D.B. (2008). Hope, truth, and preparing for death: perspectives of surrogate decision makers. Annals of Internal Medicine 149 (12), 861-868.

. Rustoen, T., Wahl, A.K., Hanestad, B.R., Gjengedal, E. & Moum, T. (2004). Expressions of hope in cystic fibrosis patients: a comparison with the general population. Heart & Lung 33 (2), 111-118.

. Rustoen, T., Cooper, B.A. & Miaskowski, C. (2010). The importance of hope as a mediator of psychological distress and life satisfaction in a community sample of cancer patients. Cancer Nursing 33 (4), 258-267.

. Greenberg, C.C., Regenbogen, S.E., Lipsitz, S.R., Diaz-Flores, R. & Gawande, A.A. (2008). The frequency and significance of discrepancies in the surgical count. Annals of Surgery 248 (2), 337-341.

. Shively, E.H., Heine, M.J., Schell, R.H., Sharpe, J.N., Garrison, R.N., Vallance, S.R. & DeSimone, K.J. (2004). Practicing surgeons lead in quality care, safety, and cost control. Annals of Surgery 239 (6), 752-760.

. Shortell, S.M., Zimmerman, J.E., Rousseau, D.M., Gillies, R.P., Wagner, D.P., Draper, E.A., Knaus, W.A. & Duffy, J. (1994). The performance of intensive care units: does good management make a difference? Medical Care 32 (5), 508-525.

. Makary, M.A., Mukherjee, A., Sexton, J.B., Syin, D., Goodrich, E., Hartmann, E., Rowen, L., Behrens, D.C., Marohn, M. & Pronovost, P.J. (2007). Operating room briefings and wrong-site surgery. Journal of the American College of Surgeons 204 (2), 236-243.

. Makary, M.A., Sexton, J.B., Freischlag, J.A., Millman, E.A., Pryor, D., Holzmueller, C. & Pronovost, P.J. (2006). Patient safety in surgery. Annals of Surgery 243 (5), 628-632.

. Mutter, M. (2003). One hospital's journey toward reducing medication errors. Joint Commission Journal on Quality and Patient Safety 29 (6), 279-288.

. Bumpus, L. & al-Assaf, A.F. (2003). Using performance improvement strategies to reduce and prevent medication errors. 1. Journal of Cardiovascular Management 14 (5), 11-15.

. Kazandjian, V.A. (2004). Does appropriate prescribing result in safer care? Quality and Safety in Health Care 13 (1), 9-10.

. O'Neil, A.C., Petersen, L.A., Cook, E.F., Bates, D.W., Lee, T.H. & Brennan, T.A. (1993). Physician reporting compared with medical-record review to identify adverse medical events. Annals of Internal Medicine 119 (5), 370-376.

. Weingart, S.N., Callanan, L.D., Ship, A.N. & Aronson, M.D. (2001). A physician-based voluntary reporting system for adverse events and medical errors. Journal of General Internal Medicine 16 (12), 809-814.