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Misdiagnosis more likely with ‘difficult’ patients, evidence finds

15 March 2016

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Doctors are more likely to misdiagnosis patients that are aggressive, challenging or hopeless, new research has found.

The researchers found that doctors were 42% more likely to misdiagnose a difficult patient in a complex case and 6% more likely to do so in a simple case, the results – published in BMJ Quality & Safety – revealed.

They worked with 63 doctors who were in their last year of specialty training to become a family doctor, and either gave them a neutral or difficult patient to diagnose with one of six conditions, as quickly as possible.

The difficult behaviours included: being demanding or aggressive, questioning the doctor’s competence, ignoring the doctor’s advice, acting utterly helpless, and not expecting the doctor to take them seriously.

The findings were still true regardless of the time spent on diagnosis, the study found. When the doctors had time to reflect it improved the diagnostic accuracy, but did not make up for the impact of disruptive behaviours.

“The fact is, that difficult patients trigger reactions that may intrude with reasoning, adversely affect judgments, and cause errors,” the researchers said.

The researchers from The Erasmus Medical Centre are now calling for wider awareness of this, to improve medical students’ and doctors’ diagnoses.

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