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Emotional Influences in Patient Safety

Croskerry, Pat MD, PhD; Abbass, Allan MD, FRCPC; Wu, Albert W. MD, MPH

doi: 10.1097/PTS.0b013e3181f6c01a
Original Articles

Objective: The way that health care providers feel, both within themselves and toward their patients, may influence their clinical performance and impact patient safety, yet this aspect of provider behavior has received relatively little attention. How providers feel, their emotional or affective state, may exert a significant, unintended influence on their patients, and may compromise safety.

Methods: We examined a broad literature across multiple disciplines to review the interrelationships between emotion, decision making, and behavior, and to assess their potential impact on patient safety.

Findings: There is abundant evidence that the emotional state of the health care provider may be influenced by factors including characteristics of the patient, ambient conditions in the health care setting, diurnal, circadian, infradian, and seasonal variables, as well as endogenous disorders of the individual provider. These influences may lead to affective biases in decision making, resulting in errors and adverse events. Clinical reasoning and judgment may be particularly susceptible to emotional influence, especially those processes that rely on intuitive judgments.

Conclusions: There are many ways that the emotional state of the health care provider can influence patient care. To reduce emotional errors, the level of awareness of these factors should be raised. Emotional skills training should be incorporated into the education of health care professionals. Specifically, clinical teaching should promote more openness and discussion about the provider's feelings toward patients. Strategies should be developed to help providers identify and de-bias themselves against emotional influences that may impact care, particularly in the emotionally evocative patient. Psychiatric conditions within the provider, which may compromise patient safety, need to be promptly detected, diagnosed, and managed.

From the *Departments of Emergency Medicine and Medical Education, †Centre for Emotions and Health, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; and ‡Health Policy and Management, School of Public Health, Johns Hopkins University, Baltimore, Maryland.

Correspondence: Pat Croskerry, MD, PhD, Department of Emergency Medicine and Department of Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada (e-mail:

Dr Croskerry was supported by a Senior Clinical Research Fellowship from the Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, and a grant (P20HS11592-02) from the Agency for Healthcare Research and Quality. Dr Abbass was supported by the Dalhousie University Department of Psychiatry and the Nova Scotia Department of Health. Dr Wu was supported by a grant (U18HS11902-01) from the Agency for Healthcare Research and Quality.

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