title: Emotional influences in patient safety.
abstract: 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.
  
  
  RESULTS
  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.
authors.affiliation: Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. croskerry@eastlink.ca
authors.forename: Pat
authors.initials: P
authors.lastname: Croskerry
authors.forename: Allan
authors.initials: A
authors.lastname: Abbass
authors.forename: Albert W
authors.initials: AW
authors.lastname: Wu
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001364:Awareness; D002983:Clinical Competence; D003071:Cognition; D003379:Countertransference; D003657:Decision Making; D004644:Emotions; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007600:Judgment; D019300:Medical Errors / Q000517:prevention & control; D005791:Patient Care / Q000523:psychology*; D012449:Safety; D013663:Teaching