Difficult patients increase the misdiagnosis risk according to a study published online on March 7 in the British Medical Journal Quality & Safety. These patients cause doctors to be distracted with their behaviour instead of allowing the health professionals to focus on the job and process the clinical information correctly.

The researchers explain that disruptive behaviours include being demanding, being helpless, being aggressive, ignoring the doctor’s advice, questioning the doctor’s competence and being cynical. The consequences of a patient’s behaviour on the accuracy of diagnosis has never been supported by research until now.

The research team observed how 63 doctors responded when asked to look after two versions of six clinical sex scenarios, where one had a difficult patient with a health problem and another had the same problem but had neutral behaviour or without the same difficult behaviour.

Doctor Examines Patient. Photo from Wikipedia/National Cancer Institute

Doctor examines patient. Photo from Wikipedia/National Cancer Institute

The doctors had to diagnose the patient as fast as they could based on a patient’s brief medical history, signs and symptoms of illness and the results of the physical examination. They also had to review the case to include all the needed information for the diagnosis and to offer another possible diagnosis if the first one was incorrect. They also used a Likert scale to rate the patient’s likeability.

Overall, the doctors made a more accurate diagnosis for the simpler cases. However, the patient’s behaviour affected their diagnosis accuracy. Their doctors were six percent more likely to incorrectly diagnose a simple case of a difficult patient and 42 percent more likely to do the same for complicated cases.

Even if the doctors spent ample time in evaluating all the factors present, they still misdiagnosed the difficult patients. The accuracy only improved when the doctors spent a longer time in studying the diagnosis. Difficult patients also scored lower on the likeability scale than those neutrally-behaved patients.

Another study was also conducted but this time, 74 trainee hospital doctors were involved and disruptive patients’ behaviours included threatening the doctors and accusing the doctors of discrimination.

The study revealed the same results. The difficult patients made the doctors 20 percent less likely to provide accurate diagnosis and 30 percent less likely to recall medical examination results. Still, these findings may be lower than what actually happens in real life.

The researchers recommend that physicians and medical students should be more aware of this problem. They add that healthcare professionals should consider findings from other healthcare workers, computer-assisted diagnostics and health checklists to prevent misdiagnosis.