Doctors More Likely To Misdiagnose 'Difficult' Patients, Study Finds

Turns out it pays to be polite.

If you think something is wrong with your health then being polite to your doctor might increase your chances of receiving a swift and accurate diagnosis.

That's according to a new study, which suggests patients regarded as "difficult" significantly increase their doctors’ risk of getting a diagnosis wrong.

Doctors were found to be 42% more likely to misdiagnose a "difficult" patient than a "neutral" one in a complex case, and 6% more likely to do so in a simple case.

Those who were identified as "difficult" included a demanding patient, an aggressive patient, a patient who questions the doctor’s competence, a patient who ignores the doctor’s advice and a patient who doesn’t expect the doctor to take them seriously.

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During the study, 63 doctors in the last year of their specialty training in family medicine saw patients with six different health concerns. The patients displayed either "difficult" or "neutral" behaviour.

The six conditions were: pneumonia; a blood clot in the lung (pulmonary embolism); brain inflammation (meningoencephalitis); overactive thyroid (hyperthyroidism); appendicitis; and inflammation of the pancreas caused by excessive alcohol consumption (acute alcoholic pancreatitis).

The doctors were asked to write down the most likely diagnosis as quickly as possible and then to review the same case, writing down the information for and against the diagnosis they had made, and to offer an alternative if they had got it wrong first time around.

Finally, they were asked to rate the likeability of the patient.

Unsurprisingly, the results showed that diagnostic accuracy was higher for more simple cases. But the doctors were also found to be 42% more likely to misdiagnose a "difficult" patient than a "neutral" patient in a complex case, and 6% more likely to do so in a simple case.

The findings held true, irrespective of the time spent on diagnosis. Similarly, further reflection improved diagnostic accuracy, but it didn’t make up for the impact of disruptive behaviours.

The study concludes: "Disruptive behaviours displayed by patients seem to induce doctors to make diagnostic errors. Interestingly, the confrontation with difficult patients does however not cause the doctor to spend less time on such case.

"Time can therefore not be considered an intermediary between the way the patient is perceived, his or her likeability and diagnostic performance."

The study is published online in full in British Medical Journal Quality And Safety.