Two recent studies suggest that “difficult” patients— those who demand many tests and services, and express negative feelings about thedoctor or process — are more likely to beincorrectly diagnosed.

The studies, led by Dr. Sílvia Mamede of the Institute ofMedical Education Research Rotterdam in the Netherlands, sought tovalidate age-old conventional wisdom about the effect that annoying patients can have onphysicians.

The researchers explained: “Literature suggests that patientswho display disruptive behaviors in the consulting room fuelnegative emotions in doctors. These emotions, in turn, are said tocause diagnostic errors.”

To test the theory in the first study, researchers developed six medicalvignettes that described six real patients, their symptoms, andtheir behavior, including their attitude towards medical staff. Thevignettes were presented to 63 medical residents, who were asked tomake a diagnosis based on the information.

The more aggravating the patient, the more likely the novicedoctor was to render an incorrect diagnosis.

The same was true in an accompanying study, in which 74 internalmedicine residents were presented with eight vignettes, all ofwhich described the exact same symptoms. The only differencebetween the patients described was their behavior.

“Difficult patients’ behaviours induce doctors to makediagnostic errors, apparently because doctors spend part of theirmental resources on dealing with the difficult patients’behaviours, impeding adequate processing of clinical findings,” theresearchers concluded.

So what’s the solution? A public campaign to get us to be nicerto doctors and nurses? That might be a little too ambitious. Theresearchers suggested instead that doctors be taught to recognizethe potentially disastrous effects that their annoyance with apatient might have on their work. After all, the Hippocratic Oathcompels doctors to do no harm to patients, no matter howannoying.