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

The studies, led by Dr. Sílvia Mamede of the Institute of Medical Education Research Rotterdam in the Netherlands, sought to validate age-old conventional wisdom about the effect that annoying patients can have on physicians.

The researchers explained: “Literature suggests that patients who display disruptive behaviors in the consulting room fuel negative emotions in doctors. These emotions, in turn, are said to cause diagnostic errors.”

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

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

The same was true in an accompanying study, in which 74 internal medicine residents were presented with eight vignettes, all of which described the exact same symptoms. The only difference between the patients described was their behavior.

“Difficult patients’ behaviours induce doctors to make diagnostic errors, apparently because doctors spend part of their mental resources on dealing with the difficult patients’ behaviours, impeding adequate processing of clinical findings,” the researchers concluded.

So what’s the solution? A public campaign to get us to be nicer to doctors and nurses? That might be a little too ambitious. The researchers suggested instead that doctors be taught to recognize the potentially disastrous effects that their annoyance with a patient might have on their work. After all, the Hippocratic Oath compels doctors to do no harm to patients, no matter how annoying.

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Rude to your doctor? Don't expect a correct diagnosis

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