title: Do patients' disruptive behaviours influence the accuracy of a doctor's diagnosis? A randomised experiment.
abstract: Literature suggests that patients who display disruptive behaviours in the consulting room fuel negative emotions in doctors. These emotions, in turn, are said to cause diagnostic errors. Evidence substantiating this claim is however lacking. The purpose of the present experiment was to study the effect of such difficult patients' behaviours on doctors' diagnostic performance.
  
  
  
  We created six vignettes in which patients were depicted as difficult (displaying distressing behaviours) or neutral. Three clinical cases were deemed to be diagnostically simple and three deemed diagnostically complex. Sixty-three family practice residents were asked to evaluate the vignettes and make the patient's diagnosis quickly and then through deliberate reflection. In addition, amount of time needed to arrive at a diagnosis was measured. Finally, the participants rated the patient's likability.
  
  
  
  Mean diagnostic accuracy scores (range 0-1) were significantly lower for difficult than for neutral patients (0.54 vs 0.64; p=0.017). Overall diagnostic accuracy was higher for simple than for complex cases. Deliberate reflection upon the case improved initial diagnostic, regardless of case complexity and of patient behaviours (0.60 vs 0.68, p=0.002). Amount of time needed to diagnose the case was similar regardless of the patient's behaviour. Finally, average likability ratings were lower for difficult than for neutral-patient cases.
  
  
  
  Disruptive behaviours displayed by patients seem to induce doctors to make diagnostic errors. Interestingly, the confrontation with difficult patients does however not cause the doctor to spend less time on such case. Time can therefore not be considered an intermediary between the way the patient is perceived, his or her likability and diagnostic performance.
authors.affiliation: Department of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: H G
authors.initials: HG
authors.lastname: Schmidt
authors.affiliation: Department of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Tamara
authors.initials: T
authors.lastname: Van Gog
authors.affiliation: Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Stephanie Ce
authors.initials: SC
authors.lastname: Schuit
authors.affiliation: Department of Internal Medicine, Admiraal de Ruyter Hospital, Goes, The Netherlands.
authors.forename: Kees
authors.initials: K
authors.lastname: Van den Berge
authors.affiliation: Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Van Daele
authors.affiliation: Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Herman
authors.initials: H
authors.lastname: Bueving
authors.affiliation: Department of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Tim
authors.initials: T
authors.lastname: Van der Zee
authors.affiliation: Institute of Medical Education Research Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Walter W
authors.initials: WW
authors.lastname: Van den Broek
authors.affiliation: Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Jan L
authors.initials: JL
authors.lastname: Van Saase
authors.affiliation: Institute of Medical Education Research Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Sílvia
authors.initials: S
authors.lastname: Mamede
mesh_terms: D000328:Adult; D003933:Diagnosis; D003951:Diagnostic Errors / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D000066553:Problem Behavior / Q000523:psychology
keywords: Decision making; Diagnostic errors; Medical education