Risk of diagnostic errors when dealing with aggressive patients: Experimental study.

Abstract

Medical errors are still common despite advances in technology and policies to insure patients' safety. They can be traceable as in medications or surgical errors, but may not be so in diagnostic errors that are patient, physician, or system related. This study aimed to explore whether aggressive behavior of some patients might affect physicians' clinical reasoning and decision-making. The study was conducted in a format of observation skills clinical examinations (OSCEs). It included simulating patients (SPs) and family physicians in residency training in a clinical setup. The experiment included two arms of dealing with case scenarios with "Neutral" and "Aggressive" behaviors. Explanatory variables assessed were duration of consultation, correct diagnosis, and plan of appropriate management as well as patients' satisfaction. Participants were 14 trained SPs who played the roles of aggressive and nonaggressive patients when they encountered 35 residents (18 were males) in family physicians [year 2 (R2), year 3 (R3) and year 4 (R4)]; in a total of seventy patient/doctor encounters. Compared with nonaggressive patients, aggressive patients had statistically significantly prolonged OSCE duration [mean (standard deviation) = 6.89 (1.35) and 6.11 (157) min, respectively; P = 0.031] and more patient consultation satisfaction (P <0.0001). However, no statistically significant differences were found in diagnostic accuracy (P = 0.626) and management (P = 0.621). In a stratified analysis, junior doctors had longer duration of consultation and seemed to perform better in management (higher patient satisfaction and better management outline) than their senior counterparts. Patients' aggressive behavior led to longer duration of medical consultation. Poor management plan, albeit correct diagnosis, in senior doctors may be due to disruptive clinical reasoning in disturbed stressful situation. Coping strategies should be emphasized in medical education to ensure effective clinical reasoning in patient/doctor encounters.