Medical residents were more likely to misdiagnose demanding, aggressive, and combative patients than they are more passive patients with the same symptoms, a new study has found. That was true even though the physicians devoted the same amount of time to both types of patients.
, of Erasmus University Rotterdam, and colleagues gave 63 medical residents vignettes of patients exhibiting various degrees and types of annoyances. They then assigned identical symptoms to patients who were agreeable. The residents were asked to make a quick diagnosis and also a more thoughtful diagnosis for a mix of simple and more complex cases. Outside evaluators assigned accuracy scores of 0 for incorrect diagnoses, 0.5 for correct diagnoses, and 1 for complete, accurate diagnoses.
The results, , showed clear differences based on patients' behavior. On simple cases, doctors diagnosing troublesome patients were slightly less accurate. But for complex cases, a big difference emerged: doctors were almost twice as likely to misdiagnose the difficult patients.
Interestingly, the amount of time doctors spent on cases was not a factor -- they dealt with the difficult patients' cases for just as long as with the nicer ones.
in the journal from the same group sought to explain the discrepancy. Checks on what the residents recalled from the encounters showed that they were more likely to remember how disruptive patients behaved, and slightly less likely to remember their clinical findings.
"[D]octors would not have more resources available for difficult patients than for neutral patients," Schmidt and colleagues explained.
"Because troublesome behaviors consume part of scarce mental resources, diagnostic accuracy suffers."