Mark Linzer, MD; Linda Baier Manwell, MS; Eric S. Williams, PhD; James A. Bobula, PhD; Roger L. Brown, PhD; Anita B. Varkey, MD; Bernice Man, MD; Julia E. McMurray, MD; Ann Maguire, MD, MPH; Barbara Horner-Ibler, MD, MASW; Mark D. Schwartz, MD; MEMO (Minimizing Error, Maximizing Outcome) Investigators
Presented in part at the 31st Annual Meeting of the Society of General Internal Medicine, Pittsburgh, Pennsylvania, 11 April 2008.
Grant Support: By the Agency for Healthcare Research and Quality (grant 5 R01 HS011955).
Potential Financial Conflicts of Interest:Employment: Dr. Man was formerly employed at one of the study sites. Grants received: M. Linzer (Agency for Healthcare Research and Quality). Ms. Manwell's salary was partially funded by the grant from the Agency for Healthcare Research and Quality.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Brown (email@example.com).
Requests for Single Reprints: Mark Linzer, MD, University of Wisconsin School of Medicine and Public Health, General Internal Medicine, 310 North Midvale Boulevard, Suite 205, Madison, WI 53705; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Linzer and Ms. Manwell: University of Wisconsin Section of General Internal Medicine Scholars, 310 North Midvale Boulevard, Suite 205, Madison, WI 53705.
Dr. Williams: Department of Management and Marketing, Culverhouse College of Commerce and Business Administration, University of Alabama, 164 Alston Hall, Box 870225, Tuscaloosa, AL 35487-0225.
Dr. Bobula: University of Wisconsin, Department of Family Medicine, 777 South Mills Street, Madison, WI 53715.
Dr. Brown: University of Wisconsin–Madison School of Nursing, H6/273 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792.
Dr. Varkey: Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153.
Dr. Man: Rush Medical College, 1901 West Harrison Street, Chicago, IL 60612.
Dr. McMurray: William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705.
Dr. Maguire: Medical College of Wisconsin, General Internal Medicine, Froedert East Office Building, Suite 4200, 9200 West Wisconsin Avenue, Milwaukee, WI 53226.
Dr. Horner-Ibler: Bread of Healing Clinic, 1821 North 16th Street, Milwaukee, WI 53205.
Dr. Schwartz: Veterans Affairs New York Harbor Healthcare System, 423 East 23rd Street, Suite 15N, New York, NY 10010.
Author Contributions: Conception and design: M. Linzer, L.B. Manwell, E.S. Williams, B. Man, J.E. McMurray, B. Horner-Ibler, M.D. Schwartz.
Analysis and interpretation of the data: M. Linzer, L.B. Manwell, J.A. Bobula, R.L. Brown, J.E. McMurray, M.D. Schwartz.
Drafting of the article: M. Linzer, L.B. Manwell, E.S. Williams.
Critical revision of the article for important intellectual content: M. Linzer, L.B. Manwell, E.S. Williams, J.A. Bobula, R.L. Brown, A. Maguire, M.D. Schwartz.
Final approval of the article: M. Linzer, L.B. Manwell, E.S. Williams, R.L. Brown, A.B. Varkey, A. Maguire, B. Horner-Ibler, M.D. Schwartz.
Provision of study materials or patients: L.B. Manwell, A.B. Varkey, B. Man, A. Maguire, B. Horner-Ibler, M.D. Schwartz.
Statistical expertise: E.S. Williams, J.A. Bobula, R.L. Brown.
Obtaining of funding: M. Linzer, L.B. Manwell, E.S. Williams.
Administrative, technical, or logistic support: M. Linzer, L.B. Manwell, A.B. Varkey, J.E. McMurray, B. Horner-Ibler.
Collection and assembly of data: L.B. Manwell, J.A. Bobula, A.B. Varkey, B. Man, J.E. McMurray, A. Maguire, B. Horner-Ibler, M.D. Schwartz.
For a list of the MEMO investigators, see the Appendix.
Linzer M, Manwell LB, Williams ES, Bobula JA, Brown RL, Varkey AB, et al. Working Conditions in Primary Care: Physician Reactions and Care Quality. Ann Intern Med. 2009;151:28-36. doi: 10.7326/0003-4819-151-1-200907070-00006
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Published: Ann Intern Med. 2009;151(1):28-36.
In 2001, Eisenberg and colleagues (1) and Sainfort and associates (2) wrote about “healthy workplaces”—those that sustain both providers and patients. Their concern was that unhealthy work environments could adversely affect physicians and, ultimately, their patients. Reports that linked physician job dissatisfaction to poorer patient medication adherence (3) and physician stress to medical errors (4) supported this concern. However, few formal assessments of the relationship among work environments, physician reactions, and care quality have been performed. The current decline in medical student interest in primary care careers brings heightened importance to these issues (5).
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