'Disruptive' patients more likely to cause GP misdiagnosis

According to a recent study, patients displaying ‘difficult’ behaviour increase GPs’ risk of getting a diagnosis wrong. Kirsty Plowman reports

A study on whether patients’ disruptive behaviours influence the accuracy of a doctor’s diagnosis found that doctors were 42% more likely to misdiagnose a ‘difficult’ patient than a ‘neutral’ one in a complex case.

The study, by researchers from the Erasmus University in Rotterdam, Netherlands and published in BMJ Quality & Safety¹, found that a GP’s decision-making becomes impaired because they dedicate so much mental resources to their patients’ emotional behaviour.

It concluded: “Disruptive behaviours displayed by patients seem to induce doctors to make diagnostic errors.

“Efforts should be made to increase doctors’ awareness of the potential negative influence of difficult patients’ behaviours on diagnostic decisions and their ability to counteract such influence.”

Dr Pallavi Bradshaw, Senior Medicolegal Adviser at Medical Protec     tion, said: “In this ‘information era’, patients are better informed about their health and what modern medicine can achieve. Engaged patients are valuable for GPs; however these high expectations can cause conflict between what the patient wants and what the GP can deliver, leading to difficult discussions.

“Dealing with challenging patients, particularly when they are abusive, understandably impacts on GPs’ stress levels, morale and fear of litigation – which in turn can negatively affect patient care.”

A 2015 Medical Protection survey² suggested that over half of GPs face a challenging consultation with a patient on a weekly basis.

The GPs surveyed blamed unrealistic expectations (72% of respondents) – with 93% believing that patient expectations are higher than five years ago – followed by alcohol/drug misuse by patients (41%).

Nearly three quarters of respondents had experienced verbal abuse, while 74% had faced aggressive demands for treatment or drugs and 51% had witnessed violent or aggressive behaviour.

These challenging encounters had a negative impact on practice life: 94% reported stress and anxiety, 77% believed their workload increased from dealing with the repercussions, and 66% said it caused delays in appointments.

Dr Pallavi Bradshaw added: “We also want to remind members that Medical Protection is here to offer advice, support and guidance throughout a member’s career.”

Find out more

• Your membership offers access to a wide range of risk management resources and support. Find out more information about our workshops such as Managing Difficult Interactions with Patients or Managing Conflict and Aggression in General Practice.  
• If you face a situation like this and require advice or support then contact one of our medicolegal advisers on 0113 241 0200 or email [email protected]

References

1. Mamede S et al, Why patients’ disruptive behaviours impair diagnostic reasoning: a randomised experiment, BMJ Qual Saf (2016)
2. Medical Protection conducted a survey of 254 UK GP members in 2015 on the issue of ‘challenging interactions with patients’

Please note: Medical Protection does not maintain this article and therefore the advice given may be incorrect or out of date, and may not constitute a definitive or complete statement of the legal, regulatory and/or clinical environment. MPS accepts no responsibility for the accuracy or completeness of the advice given, in particular where the legal, regulatory and/or clinical environment has changed. Articles are not intended to constitute advice in any specific situation, and if you are a member you should contact Medical Protection for tailored advice. All implied warranties and conditions are excluded, to the maximum extent permitted by law.