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‘Difficult’ patients more likely to cause GP misdiagnosis

Patients displaying ‘difficult’ behaviour increase GPs’ risk of getting a diagnosis wrong, according to a study published today.

The study by researchers from the Erasmus University in Rotterdam, Netherlands and published in BMJ Quality & Safety concluded that GPs devote so much mental resources to their patients’ emotional behaviour that their decision-making becomes impaired.

But the researchers concluded that the patients’ difficult behaviour did not lead the GPs to spend less time with them.

The study cited previous research that found that around 15% of patients were ‘hard to see’, displaying argumentative or aggressive behaviour.

The GPC said that the study showed the need to work on reducing stress for GPs.

The study, on whether patients’ disruptive behaviours influence the accuracy of a doctor’s diagnosis, presented 63 GPs in their last year of medical training with six ‘vignettes’.

The vignettes depicted three diagnostically simple cases, and three diagnostically complex cases. The patients were a mix of ‘difficult’ – displaying distressing behaviours – and ‘neutral’.

The GPs were asked to evaluate the vignettes and make each patient’s diagnosis quickly, and then through deliberate reflection.

It found that doctors were 42% more likely to misdiagnose a ‘difficult’ patient than a ‘neutral’ one in a complex case and were 6% more likely to do so in a simple one.

The study concluded: ‘Disruptive behaviours displayed by patients seem to induce doctors to make diagnostic errors.

‘The emotion-triggering patient’s behaviours may capture so many of the doctors’ mental resources that fewer resources are left to deal with the clinical findings of the case, thereby impairing decision-making.’

It added: ‘Interestingly, the confrontation with difficult patients does however not cause the doctor to spend less time on such case.’

GPC clinical and prescribing chair Dr Andrew Green said: ‘One of the hardest skills GPs need to learn is the ability to put aside our personal feelings about patients and provide them all with the same level of service. This is not an easy thing to do, and we don’t always succeed, but it remains at the heart of our professionalism.

‘Bad things tend to happen when doctors are hungry, angry, late or tired, so it is sad that many GPs are forced to be in these states for much of their working day. Those with the power to change things need to place reducing these adverse factors at the centre of their policies.’