Letters to the Editor
In Reply to Walsh: We agree wholeheartedly with Dr. Walsh. In our commentary, we argue that quality of care, health care costs, and clinician resilience and well-being are closely linked, and that physicians who care for themselves are “less likely to commit errors, be impaired, or leave practice, all of which are costly to the health care system.” Articles by our group and others1–6 suggest specific mechanisms whereby greater mindfulness confers resilience and well-being while at the same time reducing the likelihood of diagnostic and technical errors. We share Dr. Walsh’s concern, stating in our commentary that “the general public may not be very sympathetic to an argument that physicians need to augment their well-being.”7 However, currently there are few studies of the effect of resilience-promoting strategies on quality of care, clinical outcomes, and costs.8 We look forward to more robust research that can document the savings in terms of the lives of our patients and costs to the health care system.
Ronald M. Epstein, MD
Professor of family medicine, psychiatry, oncology, and nursing; director, Dean’s Teaching Fellowship Program; and director, Center for Communication and Disparities Research, University of Rochester Medical Center, Rochester, New York; Ronald_Epstein@URMC.Rochester.edu.
Michael S. Krasner, MD
Clinical associate professor of medicine, University of Rochester Medical Center, Rochester, New York.
1. Borrell-Carrió F, Epstein RM. Preventing errors in clinical practice: A call for self-awareness. Ann Fam Med. 2004;2:310–316
2. Leung ASO, Epstein RM, Moulton CAHodges BD, Lingard L. The competent mind: Beyond cognition. The Question of Competence. 2012 Ithaca, New York Cornell University Press:155–176
3. Moulton CA, Epstein RMFry H, Kneebone R. Self-monitoring in surgical practice: Slowing down when you should. Surgical Education: Theorising an Emerging Domain.;Vol 22011:169–182
4. Moulton CA, Regehr G, Lingard L, Merritt C, MacRae HM. Staying out of trouble in the operating room: Remaining attentive in automaticity. Acad Med. 2010;85:1571–1577
5. Moulton CA, Regehr G, Mylopoulos M, MacRae HM. Slowing down when you should: A new model of expert judgment. Acad Med. 2007;82(10 suppl):S109–S116
6. Sibinga EM, Wu AW. Clinician mindfulness and patient safety. JAMA. 2010;304:2532–2533
7. Epstein RM, Krasner MS. Physician resilience: What it means, why it matters, and how to promote it. Acad Med. 2013;88:301–303
8. Jones JW, Barge BN, Steffy BD, Fay LM, Kunz LK, Wuebker LJ. Stress and medical malpractice: Organizational risk assessment and intervention. J Appl Psychol. 1988;73:727–735