Ask any medical student who hasn't caved under the unbearable pressure and they will tell you first hand: choosing a job in the field entails years of intense work and corollary anxiety, and nearly every student can recall questioning his or her decision to go into medicine at least once. The skill and persistence with which each individual deals with this stress is likely to serve as an important indicator of his or her relative competence as a doctor.
Unfortunately, the considerable responsibilities that accompany any path toward a career in medicine can have adverse effects on young doctors-in-training and foster inferior care for their patients. The state of burnout, or a seeming inability to endure the harsh realities of med student life, is unbelievably common. Anxiety, insomnia and extremely limited amounts of free time for stress relief can also create or compliment cases of clinical depression, and a new study indicates that depressed doctors (or at least students in residence) are far more likely to commit medical mistakes that can prove costly and, in extreme cases, fatal. These errors include the act of giving patients the wrong drugs or the wrong doses as well as misdiagnosis, misinterpretation of medical orders and unresolved problems with equipment. The problem is not a small one; field experts assert that "preventable medication errors account for 10-20% of adverse events in patients admitted to hospital," and an estimated 44,000-98,000 patients die each year in the United States due to medical errors. At least 7,000 of those deaths can be attributed to medication alone.
The largest theoretical solution designed by the FDA involves requiring bar codes on all medications to avoid any possibility of confusion regarding medications and doses. This proposal, though laudable, does not counter the significant problem outlined by the recently-published study of 123 pediatric residents at 3 American children's hospitals: its data revealed that a disturbingly high percentage (20%) of doctors-in-training meet the diagnostic criteria for depression and even more suffer from its predecessor/contributor, the dreaded burnout syndrome (74%). Most importantly, depressed subjects were a full 6 times as likely to make medical errors of some sort during the study's duration. On a more encouraging note, simple burnout did not account for nearly as many direct mistakes as full depression; students in the study who reported burnout but not depression did not make any more errors than those who were seemingly unaffected by either condition. Frustration was not enough to distract these residents from the all-important task at hand, and this is certainly a good thing. Still, if 1 in 5 residents suffers from depression and works 80 hours a week in the clinic or hospital, the possibility of serious mistakes grows considerably larger.
The study is somewhat limited by size and its conclusions are, therefore, not particularly overwhelming, but the larger point has been made: doctors and all others working in a hospital setting should be screened for mental illness and treated immediately if its presence is confirmed. The issue relates less to the doctors' health (though that cannot be discounted) and more to the safety of their patients. Despite these ominous statistics, we should find some reassurance in the fact that the residents in the study, as a group, only made an average of 1.5 errors per month.
Doctors, though most work diligently for the public good, are not simply neutral parties immune to the influence of mental illness. Their demanding schedules and notable lack of both sleep and leisure time can be even more pronounced during the many years they spend slogging through the medical school experience which includes time in residency, and the increased rates of depression among their number are hardly surprising. Thankfully, nationwide standards on work hours for residents have been revised since this study was performed; where residents once worked as many as 120 hours per week, current policy sets the limit at 80. This revision, combined with the bar code policy, should prevent some potential emergencies, but these efforts are obviously not enough. Instituting mandatory mental health screenings for all hospital workers seems like a natural step in the right direction.
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