Difficult, unpleasant or suspicious patients have a 42% more risk of being misdiagnosed when the pathology is a little complicated.
General practitioners sometimes have to deal with difficult patients. Tired, irritated by the wait, depressed, simply disrespectful or downright unpleasant, they all put themselves at risk of misdiagnosis. This is what a study carried out at the University of Rotterdam (Netherlands) reveals, and published in BMJ quality & safety.
The researchers brought together 63 future family physicians in their final year of apprenticeship. They placed them in front of examination scenarios supposed to lead to the diagnosis of one pathology among six to choose from. Each could appear in two different forms: either in a normal patient or in a distressing patient.
Issue a rapid diagnosis
Each difficult patient was categorized as very demanding, aggressive, suspicious of the physician’s skills, unruly regarding advice, doubtful about the physician’s ability to take him seriously, or completely disillusioned.
The six diseases were divided into two groups: three were considered easy to diagnose – pneumonia, pulmonary embolism and meningoencephalitis -, and three more complicated – hyperthyroidism, acute pancreatitis of alcoholic origin and appendicitis.
At each consultation, future doctors had to issue a rapid diagnosis based on the information from the scenario presented. They could then go over the description at greater length, and possibly revise their judgment.
Bad diagnoses, even when taking your time
For the three simplest pathologies, the number of misdiagnoses was 6% higher in difficult patients compared to classic patients. For complicated diagnoses, it was 42%! And while the review lowered the percentage of misdiagnoses, it wasn’t enough to catch up.
“This suggests that the mental energy expended to apprehend the problematic behavior interferes with the assimilation of clinical information,” the researchers explain. They also believe that these effects obtained without direct contact with patients could be even greater in real life, and that students should therefore be trained and a way to be better prepared to cope with their patient population.
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