That’s the implication of two new studies published in the journal BMJ Quality & Safety.Separately, the authors demonstrated that clinicians are more likely to make errors of judgment when they’re treating frustrating and difficult patients.

In the first study, the researchers asked 63 family medicine residents at the Erasmus Medical Center in Rotterdam, Netherlands, to read through one of two versions of six patient cases: One version involved a difficult patient; the other, a patient with an identical health issue but a more neutral attitude. (The “difficult” patients were described as being demanding or aggressive, or even questioning their doctor’s credentials.)

The authors found that even when the medical issues were identical, the doctors provided less accurate diagnoses when faced with disruptive patients. And the effects weren’t small. When the patients’ medical problems were complex, the doctors made 42 percent more mistakes diagnosing difficult patients compared with more agreeable ones. Among simpler cases, they made 6 percent more errors with troublesome patients compared with neutral ones.

In a second study, 74 hospital doctors (also in the Netherlands) were asked to come up with diagnoses for eight clinical vignettes. Again, half involved difficult patients and the other half more agreeable types. Afterward, the doctors were asked for their diagnoses and to recall clinical and behavioral details about the patients.

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Image: By Bill Branson (Photographer) – https://visualsonline.cancer.gov/details.cfm?imageid=2392, Public Domain, https://commons.wikimedia.org/w/index.php?curid=36851756

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