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As the difficulty in dealing with a patient goes up, diagnostic accuracy goes down, according to a new report published in BMJ Quality and Safety. The complexity of the ultimate diagnosis and the amount of time spent with the patient appear to have no bearing on the probability of making a correct diagnosis. The article is based on two studies in the Netherlands that showed physicians were more likely to misdiagnose patients who exhibited “disruptive behaviors” than patients who engage in neutral or nondisruptive behaviors. Both studies showed a 20% reduction in diagnostic accuracy for difficult patients, although time spent on diagnoses was similar for both difficult and neutral patients. An accompanying editorial suggests that “imagining the patient as easy instead of difficult” might help clinicians avoid “distracting emotions” and thereby manage difficult patients better.

Difficult Patients May Be More Difficult to Diagnose