Overworked Doctors May Jeopardize Patient Safety

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Some doctors say they care for more hospitalized patients than they can handle, which may compromise patient safety, a new study finds.

The study surveyed about 500 hospitalists, physicians who manage patients' care in hospitals. Forty percent of respondents said that, at least once a month, they took on more patients than they could safely handle. And, often, this occurred more frequently.

About a quarter of doctors said their high workload prevented them from fully discussing treatment options with patients, and 22 percent said they sometimes ordered unnecessary tests because they didn't have enough time to examine the patients' cases.

"If a hospitalist is short on time and a patient is having chest pains, for example, the doctor may be more likely to order additional tests, prescribe aspirin and call a cardiologist, all because there isn't adequate time to immediately and fully evaluate the patient," said study researcher Dr. Henry Michtalik, an assistant professor of medicine at the Johns Hopkins University School of Medicine in Baltimore.

A smaller portion of doctors (5 to 10 percent) said some of their patients likely suffered adverse events — such as requiring transfer to an intensive care unit, or even death — because of the physician's workload.

Monetary concerns may help explain the workloads, Michtalik said. Efforts to reduce health care costs may lead to a decrease in physician reimbursement, which in turn prompts doctors to take on more patients, he said.

The findings suggest that hospitals need to evaluate doctors' workloads and create standards for safety, the researchers said. While there are limits on how many hours residents, or doctors-in-training, can work, there are no such guidelines for higher-level doctors known as attending physicians, Michtalik said.

Future research may shed light on the best ways to keep workloads safe, as well as methods to better manage patients when doctors are overloaded, Michtalik said.

An upcoming study by Michtalik and colleagues will examine factors associated with safe physician workloads. For example, the area of the hospital in which physicians and their teams work may make a difference. Allocating one particular area of the hospital to one provider may allow doctors to safely take on more patients by reducing the time they spend traveling around the hospital, Michtalik said.

The new study is published online today (Jan. 28) in the journal JAMA Internal Medicine.

Pass it on: Forty percent of hospital physicians say they take on more patients than they can safety handle at least once per month.

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