Disruptive Patients Distract Docs, May Receive Compromised Care

HealthDay News — Disruptive patients may get worse care from physicians, according to a study published online in BMJ Quality & Safety. The findings aren’t definitive because the researchers tested how physicians responded in fictional vignettes, instead of real-life encounters. Still, the results suggest that such patients distract physicians from doing their jobs.

The researchers created vignettes about “neutral” patients and “disruptive” patients who do things such as make frequent demands, ignore the doctor’s advice, and act helpless. Then they asked physicians to diagnose the patients.

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In one study of 63 family medicine physicians from Rotterdam, doctors made 42% more mistakes in disruptive than in non-disruptive patients when the cases were complex, and 6% more mistakes when the cases were simple. The other study, which included 74 internal medicine residents, produced similar findings: In cases considered to be moderately complex, “doctors made 20% more mistakes in difficult compared to neutral patients,” Silvia Mamede, MD, PhD, who worked on both studies, told HealthDay. Mamede is an associate professor with the Institute of Medical Education Research Rotterdam at Erasmus Medical Center in the Netherlands.

“Patients who behave disruptively by displaying disrespect or aggressiveness may induce their doctors to make diagnostic mistakes,” Mamede said


Schmidt H, van Gog T, CE Schuit S et al. Do patients’ disruptive behaviours influence the accuracy of a doctor’s diagnosis? A randomised experiment: Table 1. BMJ Qual Saf. 2016:bmjqs-2015-004109. doi:10.1136/bmjqs-2015-004109.