Mean diagnostic accuracy scores 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.
The researchers concluded that difficult patients’ behaviours induce doctors to make diagnostic errors, apparently because doctors spend some of their mental resources on dealing with the difficult patients’ behaviours, impeding the adequate processing of clinical findings. Sometimes clinical reasoning requires lots of cognitive effort. The researchers state that efforts should be made to increase doctors’ awareness of the potential negative influence of difficult patients’ behaviours on clinical decision making.
The accompanying editorial has some suggestions on how we can do that.