In Reply In response to the letter by Jansen, we acknowledge our study’s1 limitations of pooling cross-sectional data, and we based our sensitivity analyses mostly on prospective studies. The assessment methods of patient safety outcomes were considered in the subgroup analyses. In most studies, physicians were asked to self-report patient safety incidents. A few studies used surveillance methods to assess whether patient safety incidents occurred. However, none of these studies had detailed case note reviews using standardized assessment protocols and independent reviewers, which is the gold-standard approach for investigating the incidence and nature of patient safety incidents and adverse events in the process of health care.2
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Panagioti M, Hodkinson A, Esmail A. Clarifications Needed on Study of Association Between Physician Burnout and Patient Safety—Reply. JAMA Intern Med. 2019;179(4):593–594. doi:10.1001/jamainternmed.2019.0152
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