RT Journal Article
SR Electronic
T1 Do patients' disruptive behaviours influence the accuracy of a doctor's diagnosis? A randomised experiment
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 19
OP 23
DO 10.1136/bmjqs-2015-004109
VO 26
IS 1
A1 H G Schmidt
A1 Tamara van Gog
A1 Stephanie CE Schuit
A1 Kees Van den Berge
A1 Paul LA Van Daele
A1 Herman Bueving
A1 Tim Van der Zee
A1 Walter W Van den Broek
A1 Jan LCM Van Saase
A1 Sílvia Mamede
YR 2017
UL http://qualitysafety.bmj.com/content/26/1/19.abstract
AB Background Literature suggests that patients who display disruptive behaviours in the consulting room fuel negative emotions in doctors. These emotions, in turn, are said to cause diagnostic errors. Evidence substantiating this claim is however lacking. The purpose of the present experiment was to study the effect of such difficult patients’ behaviours on doctors’ diagnostic performance.Methods We created six vignettes in which patients were depicted as difficult (displaying distressing behaviours) or neutral. Three clinical cases were deemed to be diagnostically simple and three deemed diagnostically complex. Sixty-three family practice residents were asked to evaluate the vignettes and make the patient's diagnosis quickly and then through deliberate reflection. In addition, amount of time needed to arrive at a diagnosis was measured. Finally, the participants rated the patient's likability.Results Mean diagnostic accuracy scores (range 0–1) were significantly lower for difficult than for neutral patients (0.54 vs 0.64; p=0.017). Overall diagnostic accuracy was higher for simple than for complex cases. Deliberate reflection upon the case improved initial diagnostic, regardless of case complexity and of patient behaviours (0.60 vs 0.68, p=0.002). Amount of time needed to diagnose the case was similar regardless of the patient's behaviour. Finally, average likability ratings were lower for difficult than for neutral-patient cases.Conclusions Disruptive behaviours displayed by patients seem to induce doctors to make diagnostic errors. Interestingly, the confrontation with difficult patients does however not cause the doctor to spend less time on such case. Time can therefore not be considered an intermediary between the way the patient is perceived, his or her likability and diagnostic performance.