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Research links difficult patients with medical errors

Oregon residents who are polite to their doctors are more likely to receive an accurate diagnosis according to research published in BMJ Quality and Safety. Two studies looked into how often doctors made mistakes when diagnosing difficult or uncooperative patients, and researchers discovered that error rates shot up by as much as 42 percent when the conditions being diagnosed were complex.

Health care safety experts have long felt that doctors dealing with difficult patients make more mistakes, but they now have the empirical evidence to back up these beliefs. One study into this phenomenon involved over 60 practitioners and evaluated their diagnostic abilities when presented with patients sorted into categories of neutral and difficult. Behavior that could lead to a patient being classed as difficult included questioning the skills or qualifications of the doctor, disobeying medical orders, ignoring advice and making unreasonable demands.

The researchers found that difficult patients with straightforward conditions were misdiagnosed about 6 percent more often than neutral patients. However, the error rate shot up to 42 percent for complex conditions like pulmonary embolisms. A second survey of 74 doctors also found more diagnostic mistakes among difficult patients. It is believed that the increased errors are caused by the stress that doctors feel when they are persistently questioned combined with the mentally draining nature of dealing with high maintenance individuals.

Doctors are expected to provide a level of care at least comparable with generally accepted medical guidelines, and they may face lawsuits when their behavior fails to live up to this standard. Lawsuits brought in connection with a misdiagnosis often hinge on complex testimony that may be difficult to follow, and attorneys for the plaintiffs may call upon medical experts to make these complicated matters more easy for juries to understand.

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