Are "Picky" Patients More Likely to Receive a Misdiagnosis?
The headlines from two research papers, published in BMJ Quality and Safety today suggest “picky” or troublesome patients are more likely to receive a misdiagnosis by their doctor. Does this report suggest we should all go back to the days of unquestioning reference to our doctors or that our doctors may be less tolerant?
This report is based on a sample of patients who were given certain characteristics to exhibit during a consultation. The results suggested that if a patient was more aggressive or asked lots of tricky questions, the doctor may misdiagnose the problem.
From my experience in dealing with complaints and discussing matters with medical staff in all areas of the NHS, it is clear that aggressive and bullying behaviour by patients does cause difficulties. There can however be any number of reasons for that behaviour. Doctors should understand and mange certain psychological symptoms which may be caused by certain physical illnesses. However, this report appears to refer to more general aggressive complaints by patients. I can appreciate that some of this behaviour may result from frustration and feelings of helplessness. This can be caused by waiting times, administration difficulties and also fear associated with illness itself.
When I advise patients on how to complain or raise concerns with their doctor, I recommend focusing on factual events and wherever possible avoiding the emotional allegations. It is important for complaints to be raised and lessons learned. Many patients are still reluctant to raise issues which should have been brought to the attention of managers and regulators. What this report may suggest, and has been my experience, if concerns can be set out in a reasonable and constructive manner, this will allow the dialogue between doctor and patient to continue and more progress made.
Some patients will ask me to prepare a written complaint or review a complaint they have prepared so they can let out the emotion and frustration and I can then review the letter and reposition it in a more constructive way. This has a two-fold benefit of allowing an outpouring of that frustration, some of which may need to be passed to the doctor, practice manager or NHS trust, and ensure the complaint is raised in the most constructive way possible.
Overall, it is important for us all to remember that doctors, nurses and other medical staff are all human too and in the main, are trying their very best to provide care and treatment in sometimes difficult circumstances. Patients, however, are also human and are often frightened, generally unwell and can feel ignored and dismissed. Perhaps these reports suggest that doctors and nurses who engage with their patients and have good communication skills may provide better care, and avoid mistakes and misdiagnosis. The key is communication, and if this can be maintained, both medical staff and the patient will benefit in all areas.