courtesy of DrLinda-MD.com
The saying that “the squeaky wheel gets the grease” doesn’t mean that the squeaky wheel isn’t a huge pain in the neck, and until it gets lubricated it will grate on your last nerve. The analogy is meant for those patients that doctors know all-to-well, but not in a good way.
A new study published in BMJ reveals that difficult patients are more likely to be misdiagnosed by a treating physician.
Researchers from the Netherlands asked 63 family practice residents to diagnose patients based on vignettes; some where the patients behaved in such a way that was considered distressing, and others when they were neutral. Other vignettes included simple or complex cases, and the doctors were asked to make quick diagnoses in some cases, while others they were given more time to deliberate.
The results revealed that rendering an accurate diagnosis was significantly compromised for scenarios involving difficult patients, as opposed to patients in neutral interactions. Complexity of the case, and time allotted for diagnosis, did not reveal statistically significant variation in diagnostic accuracy.
“They take an inordinate amount of time to deal with because you can’t zero in on the real problem,” according to Dr. Toni Brayer, an internist in San Francisco via the WSJ, speaking about difficult patients. “[W]hen you see their name on your schedule you say, 'Uh-oh.’”
These patients have the ability to redirect the doctor’s attention, making them unable to focus on the health problem. “You can get caught up in all the chaos and actually miss clinically relevant things,” added Dr. Brayer.
And the sad part is, that’s not all. Occasionally doctors will feel that they simply cannot handle a patient and will have to “fire” them. Although, this is not a common practice among physicians, they ultimately have no choice but to let that patient go.
Being a doctor often demands more than simply offering diagnosis and treatment. The interaction between a physician and patient is an important and complex one, and to “master” the technique of interaction is more an art form than a science. It requires wisdom and practice. Which is why I was always flabbergasted in training when a patient would bully me, but act differently in front of an attending physician.
As we have to lead by example the onus is on the doctor. It is imperative to develop the skill of dealing with difficult patients than to potentially risk missing something important.
