Patients aren't the only ones harmed by medical errors, according to a survey released Wednesday that found many doctors who make mistakes — and even those who come close — suffer stress, sleep problems and loss of confidence.

Job stress related to medical errors potentially could make some doctors prone to depression, quitting or even making additional mistakes, underscoring the need for helping them cope, said Washington University psychologist Amy Waterman, the study's lead author.

Most doctors surveyed said they would have liked counseling or other help after making mistakes, but that hospitals and other health care organizations didn't offer much assistance.

The survey involved 3,171 doctors in St. Louis, Seattle and Canada who answered mailed or e-mailed questionnaires. Most — 2,909 of them — said they had been involved with a near miss, minor medical error or serious error, which includes mistakes causing permanent or potentially life-threatening harm.

The results appear in the August edition of The Joint Commission Journal on Quality and Patient Safety, published by an affiliate of The Joint Commission, a hospital regulatory group involved in nationwide efforts to reduce medical errors.

Many of those efforts stem from an influential 1999 report that estimated that at least 44,000 Americans die each year from medical mistakes.

While the survey's scope was limited, the results echo smaller studies and likely apply to doctors elsewhere, the authors and experts not involved in the research said.

Dr. Donald Berwick, a Harvard professor who runs the Institute for Healthcare Improvement, said even more doctors might be adversely affected in regions where reforms aimed at reducing medical errors haven't taken hold.

"Nobody thinks that this excuses or should minimize" the suffering of patients harmed by errors, but it's important to emphasize that doctors suffer, too, Berwick said.

Of surveyed doctors involved in errors, 61 percent said they felt increased anxiety about the potential for future mistakes, 44 percent said they became less confident in their job abilities, 42 percent experienced sleep problems and 42 percent had a loss in job satisfaction.

Only 10 percent said hospitals offered them adequate resources for dealing with mistake-related stress.

Doctors involved in serious errors were most likely to report increased job-related stress. Still, increased stress also was reported by one-third of those involved in near-misses.

Dr. David Jaimovich, chief medical officer for The Joint Commission affiliate in suburban Chicago, said he recalls feeling stressed after a colleague got a decimal point wrong and almost gave a young patient too much medicine. Jaimovich said he and a nurse noticed the error in time but that "the first thing you think of is, 'What if?'"

Another time, he had to treat a child who'd been sickened by an overdose resulting when a colleague calculated the dose based on kilograms rather than the child's weight in pounds.

The child recovered "but we still felt terrible," Jaimovich said. He was not involved in the survey.

Historically, physicians have been looked on as being almost "super human" and when they made mistakes, "they were supposed to bite their lip, suck it up and keep going," Jaimovich said.

That perception has eased, and hospitals are starting to offer services to help doctors cope, he said.

While hospitals are increasingly adopting a more open approach to acknowledging errors, many still fear lawsuits and won't let doctors even discuss their mistakes, let alone offer them help, Berwick said.

He said doctors need self-esteem and optimism to effectively treat patients, and that more openness and coping resources for doctors could lead to improvements that would reduce errors.

"Who wants a wounded healer?" Berwick said.