Regardless of the complexity or the time spent on their case, “difficult” patients raise the risk of doctors getting a diagnosis wrong, new researches have concluded.
This is because medics who deal with the problematic behavior are less likely to focus on the task at hand and correctly process the clinical information, according to studies in the journal BMJ Quality and Safety.
Previously, there had been no empirical evidence to prove prevailing assumptions that the performance of health care providers could be affected by difficult patients, which leaves them to struggle concentrating on the medical issue.
In the first study, 63 doctors in the last year of family medicine training were given six clinical case scenarios with each involving a “neutral” or “difficult” patient. The “difficult” behaviors include aggression, being demanding, questioning the physician’s competence, ignoring the doctor’s advice, having low expectations of doctor’s support, and being “utterly helpless.”
The doctors were told to assess simple to complex conditions, such as pneumonia, pulmonary embolism or a blood clot in the lung, brain inflammation, and appendicitis.
Results demonstrated that in a complex case, 42 percent were more likely to misdiagnose a problematic patient than a neutral one. In a simple case, 6 percent were more likely to do so.
In the second study, 74 trainee doctors in hospitals diagnosed eight clinical case scenarios, equally divided into difficult and neutral behaviors. Additional behaviors involved a threatening patient and one who charges the doctor with discrimination.
Diagnostic accuracy was lower for difficult patients.
The results, the researchers said, suggest that the mental energy necessary for dealing with the "problematic behavior" gets in the way of accurately processing clinical information.
While there is a bigger picture behind doctor-patient relations and general clinical practice, difficult behaviors are likely stronger in the real world, added the authors. They also warned that these difficult patients could trigger reactions that could lead to error and impair judgment and reasoning.
In the United Kingdom, Professor David Haslam, chair of the National Institute for Health and Care Excellence (NICE) of the National Health Service, has urged patients to become more assertive in demanding the drugs and treatments they need.
"The fundamental point is it's your body – and the more you understand about the drugs you are taking, or what you might be able to have, the better you are able to work with your doctor," he says, encouraging patients to be “equal partners” with doctors and pursue their legal rights.
Haslam said patients in the UK could learn a thing or two from Americans in being confident in dealing with family doctors – as well as taking an active role in their wellness.