Much has been made of fatigue increasing the number of medical errors doctors make.

But what about other factors, like emotional stress?

That’s a little-reported issue that Pauline Chen addresses in her recent New York Times column. In residency, some doctors-in-training have to care for small children, among other life issues. As Dr. Chen notes, “whenever one of us experienced additional stress apart from our work, the house of cards in which we functioned would start to collapse. Unable to admit to or find support for our distress, we would continue to soldier on at the hospital, leaving a series of mistakes, ranging from barely perceptible to blatant, in our wake.”

And indeed, studies have shown that both distress and fatigue contribute to medical errors. More physicians today share family responsibilities, compared to eras past where “the majority of physicians were men, and their wives took care of the kids at home.”

Having residency programs recognize the impact of life stresses would be a good start.  Support programs should also be in place, along with mentors and attendings realizing that physician training today isn’t what it used to be.