Clarifications Needed on Study of Association Between Physician Burnout and Patient Safety

To the Editor The recently published Original Investigation by Dr Panagioti and colleagues¹ provides supportive evidence for concerning associations between physician burnout and a number of outcomes, including patient safety, professionalism, and patient satisfaction. The review is compelling, but we believe several clarifications are needed.

First, the authors detail overall burnout results for a number of source studies that did not report this outcome, including the study by West and colleagues,² among others. The methodology behind the generation of overall burnout associations in these cases should be provided. Second, data on demographic variables such as mean age are not reported in several source studies, including those by Fahrenkopf and colleagues,³ West and colleagues,² and Kwah and colleagues,⁴ among others, but the data appear in the Table of the article by Dr Panagioti and colleagues.¹ The approach to determining these values should be clarified. In addition, the single item applied in the study by Linzer and colleagues⁵ is not, in fact, derived from the Maslach Burnout Inventory as reported in the Table.¹ Also relevant to the Table, the cited study by Brazeau and colleagues⁶ measured burnout only among medical students, so it would seem to be ineligible for this review; the study by Qureshi and colleagues⁷ was a cross-sectional survey and not prospective as indicated; and the cited study by Shanafelt and colleagues from 2005⁸ seems intended to reference a prior study from 2002⁹ of internal medicine residents at the University of Washington. The Table in the article by Panagioti and colleagues¹ should be amended to reflect these and any other necessary corrections. Third, multiple data points in the Figures presented in the article do not match the effect sizes or confidence intervals reported in the source studies. We suspect some of these differences represent data-entry errors. We anticipate that the summary conclusions drawn by Panagioti and colleagues¹ will not change as a consequence of these corrections, but amended Figures should nonetheless be provided to maximize the trustworthiness of these results.