Medical Care Quality Reduces For 'Difficult' Patients
Patients who are difficult to deal with may tend to distract the doctor's attention away from quality care, said Dutch researchers after studying two related studies.
The experts involved in the study could not really determine why, but surmised that the doctors might be using up more of their "mental resources on dealing with the difficult patients' behaviors, impeding adequate processing of clinical findings."
The first team was captained by Silvia Mamede, an associate professor with the Institute of Medical Education Research Rotterdam at Erasmus Medical Center in the Netherlands. They revealed to 63 family medicine doctors, two sets of six clinical case situations that included either a tough or a neutral patient.
The doctors were told to fill in how they would treat them and also indicate how much they liked their patients. The likeability tended to be lower for the difficult patients.
Surprisingly, the doctors made more errors while dealing with the difficult patients, even if their medical condition was seen to be "simple". However, they spend equal amount of time with both kinds of patients.
"Disruptive behaviors displayed by patients seem to induce doctors to make diagnostic errors," the authors wrote. "Interestingly, the confrontation with difficult patients does however not cause the doctor to spend less time on such cases. Time can therefore not be considered an intermediary between the way the patient is perceived, his or her likeability and diagnostic performance."
The second study involved Mamede. They took in 74 internal medicine residents, who were told to diagnose patients in eight clinical summaries that included either difficult or neutral behaviors.
Again, the researchers made more errors while "hypothetically treating" tough patients.
"The fact is, that difficult patients trigger reactions that may intrude with reasoning, adversely affect judgments and cause errors," the researchers said.
Both studies were published in BMJ Quality & Safety.
