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

Area of Science:

• Medical Education
• Patient Safety
• Clinical Reasoning

Background:

• Medical errors persist despite technological and policy advancements.
• Diagnostic errors, unlike medication or surgical errors, are complex and multifactorial.
• Patient behavior can influence physician decision-making and patient safety.

Purpose of the Study:

• To investigate the impact of patient aggressive behavior on physician clinical reasoning and decision-making.
• To assess how patient aggression affects consultation duration, diagnostic accuracy, management plans, and patient satisfaction.

Main Methods:

• Utilized Objective Structured Clinical Examinations (OSCEs) with simulated patients (SPs) exhibiting neutral and aggressive behaviors.
• Included 35 family medicine residents (R2-R4) interacting with 14 trained SPs in 70 patient/doctor encounters.
• Measured consultation duration, diagnostic accuracy, management plan appropriateness, and patient satisfaction.

Main Results:

• Aggressive patients resulted in significantly longer consultation durations (P=0.031) and higher patient satisfaction (P<0.0001).
• No significant differences were observed in diagnostic accuracy (P=0.626) or management plan appropriateness (P=0.621).
• Junior doctors experienced longer consultations but demonstrated better management outcomes and patient satisfaction compared to senior residents.

Conclusions:

• Patient aggression extends medical consultation times but does not compromise diagnostic accuracy.
• Senior doctors may exhibit poorer management plans in stressful situations due to disrupted clinical reasoning.
• Medical education should emphasize coping strategies to enhance clinical reasoning in challenging patient encounters.