Why patients' disruptive behaviours impair diagnostic reasoning: a randomised experiment.

Autor:	Mamede S; Institute of Medical Education Research Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands., Van Gog T; Department of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands., Schuit SC; Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands., Van den Berge K; Department of Internal Medicine, Admiraal de Ruyter Hospital, Goes, The Netherlands., Van Daele PL; Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands., Bueving H; Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands., Van der Zee T; Department of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands., Van den Broek WW; Institute of Medical Education Research Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands., Van Saase JL; Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands., Schmidt HG; Department of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	BMJ quality & safety [BMJ Qual Saf] 2017 Jan; Vol. 26 (1), pp. 13-18. Date of Electronic Publication: 2016 Mar 07.
DOI:	10.1136/bmjqs-2015-005065
Abstrakt:	Background: Patients who display disruptive behaviours in the clinical encounter (the so-called 'difficult patients') may negatively affect doctors' diagnostic reasoning, thereby causing diagnostic errors. The present study aimed at investigating the mechanisms underlying the negative influence of difficult patients' behaviours on doctors' diagnostic performance. Methods: A randomised experiment with 74 internal medicine residents. Doctors diagnosed eight written clinical vignettes that were exactly the same except for the patients' behaviours (either difficult or neutral). Each participant diagnosed half of the vignettes in a difficult patient version and the other half in a neutral version in a counterbalanced design. After diagnosing each vignette, participants were asked to recall the patient's clinical findings and behaviours. Main measurements were: diagnostic accuracy scores; time spent on diagnosis, and amount of information recalled from patients' clinical findings and behaviours. Results: Mean diagnostic accuracy scores (range 0-1) were significantly lower for difficult than neutral patients' vignettes (0.41 vs 0.51; p<0.01). Time spent on diagnosing was similar. Participants recalled fewer clinical findings (mean=29.82% vs mean=32.52%; p<0.001) and more behaviours (mean=25.51% vs mean=17.89%; p<0.001) from difficult than from neutral patients. Conclusions: 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. Efforts should be made to increase doctors' awareness of the potential negative influence of difficult patients' behaviours on diagnostic decisions and their ability to counteract such influence. (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu