Do patients' disruptive behaviours influence the accuracy of a doctor's diagnosis? A randomised experiment.

Schmidt HG, van Gog T, Schuit SCE, et al. BMJ Qual Saf. 2016 Mar 7; [Epub ahead of print].

As diagnostic errors continue to rise to the forefront of patient safety, identifying specific drivers and target areas will be critical to improving diagnosis. To examine how patients' disruptive behaviors may provoke emotional responses in physicians that contribute to diagnostic inaccuracy, researchers in the Netherlands had 63 family practice residents evaluate 6 clinical vignettes that presented patients as either difficult or neutral. For patients that displayed distressing behaviors, physicians' mean diagnostic accuracy was significantly lower, even though they spent the same amount of time contemplating the diagnosis. In the related study, 74 internal medicine residents were randomized to 8 clinical vignettes that were identical except for whether the patient displayed difficult or neutral behaviors. Once again, mean diagnostic scores were significantly lower for difficult compared to neutral patients' vignettes, and time spent reaching a diagnosis was similar across groups. Physicians recalled fewer clinical findings and more behaviors from difficult-patient vignettes. This finding suggests that the devotion of mental resources to dealing with behaviors may hinder clinical processing. A recent PSNet perspective reviewed emerging progress on addressing diagnostic errors.