Study: Disruptive patients more likely to receive misdiagnoses

Patients who are angry, abusive or rude may not be receiving the best medical care, according to two studies published in BMJ Quality and Safety and covered by STAT.

For the first study, researchers from the Netherlands created vignettes in which patients either displayed disruptive behaviors or were depicted as neutral. The scenarios varied in diagnostic complexity. For both simple and complex medical situations, physicians were more likely to misdiagnose difficult patients.

In the second study, researchers attempted to discern the reason behind the diagnostic disparities presented in the initial study. After diagnosing eight clinical vignettes that were medically identical but varied in patient behavior, researchers asked physicians about each case's clinical findings and the patient's behavior. Results indicated that the decrease in diagnostic accuracy for patients exhibiting difficult behavior was largely due to the fact that physicians exhausted portions of their mental resources while mitigating the adverse patient behavior.

A companion editorial also published in BMJ shares strategies to improve care for difficult patients, such as reassessing the clinical situation once a patient's disruptive behaviors are recognized, providing diligent follow-up appointments and asking colleagues for second opinions.

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