The human component: When the patient is “difficult”
Failures in reasoning are not solely responsible for diagnostic errors. One increasingly scrutinized cause of impaired clinical judgment is the physician-patient relationship, especially one involving a “difficult” patient. Additionally, the medical literature is beginning to highlight the strong correlation between clinician fatigue or burnout and diagnostic errors.10
Patient-specific factors clearly impact the likelihood of diagnostic error. One randomized controlled trial showed that patients with disruptive behaviors negatively influence the accuracy of clinicians’ diagnoses.11 In this study, family medicine residents made 42% more diagnostic errors when evaluating complex clinical presentations involving patients with negative interpersonal characteristics (demeaning, aggressive, or demanding communication styles). Even with simple clinical problems, difficult patient behaviors were associated with a 6% higher rate of error than when such behaviors were absent, although this finding did not reach statistical significance.11
Researchers have proposed the “resource depletion” theory as an explanation for this finding.11 A patient with difficult behaviors will require additional cognitive resources from the physician to manage those behaviors.11 This leaves less cognitive capacity for solving the diagnostic problem.11 Furthermore, Riskin et al demonstrated that pediatric intensive care teams committed increased rates of medical errors and experienced poorer team performance when exposed to simulated families displaying rude behavior.12 Clearly, the power of the patient-physician relationship cannot be overstated when discussing diagnostic error.
Continue to: Strategies for reducing errors in the diagnostic process