How should you deal with misdiagnosis from doctors

Uncomfortable patients are more likely to be misdiagnosed

Sigmund Freud already suspected that the unconscious thoughts and feelings of a doctor towards the patient may have an erotic touch, but can also be latently hostile and influence his behavior. The phenomenon is called "countertransference" in psychoanalysis and is just as undesirable - after all, the treating person should be neutral - as it is inevitable. However, no empirical data has been collected until recently.

Research teams led by Henk Schmidt from the Erasmus University in Rotterdam have now published two studies in which they quantitatively get to the bottom of the phenomenon. They confronted young doctors in writing with various clinical cases, either in a version in which the patient behaves neutrally or in a variant with the same symptoms but a "difficult" patient. This was described, for example, with aggressive behavior, questioned the doctor's competence or made an extremely desperate impression.

Sympathy influences diagnosis

The test subjects, 63 and 74 doctors respectively, were asked to write down the most likely diagnosis and also rate how sympathetic they were with the person seeking help. In the second study, they were also asked to note how many clinical details and how many behaviors they remembered.

The result corresponded to what the scientists had assumed: If the patient fell into the "strenuous" category, it was six percent more likely in simple medical cases and 42 percent more likely in complicated cases to receive a misdiagnosis than with a " neutral "patient. In study two, too, the accuracy of diagnosis in difficult patients was 20 percent lower.

Difficult behavior leads to errors

In addition, doctors remembered fewer symptoms but more behaviors in the uncomfortable candidates. From this, the researchers drew the conclusion that the medical professionals had to process the problematic behavior in addition and were thereby distracted from their actual task. "Difficult patients provoke reactions that interfere with logical thinking, impair judgment and cause errors," the authors write in the specialist journal "BMJ Quality & Safety".

"This result fits in with similar study results, which suggest that unpleasant people are more likely to be confronted with unfavorable consequences," write the physicians Donald Redelmeier and Edward Etchells from the University of Toronto in the accompanying editorial. This becomes particularly clear in the classic study, according to which unattractive offenders are more likely to be sentenced to prison (77 percent) than particularly attractive ones (46 percent). It is only logical that defendants usually dress properly for court appointments and behave politely.

Neutrality is not always possible

A major disadvantage of the study is that it does not refer to real scenarios, but to questionnaire texts. Nonetheless, there seems to be something to the phenomenon. On the question of how to deal with it, Redelmeier and Etchells write: "One possible strategy for doctors would be simple self-reflection. A single doctor could also rely on teamwork to avoid potential diagnostic errors and ask colleagues for their assessment of the symptoms. "

Structured diagnosis checklists or computer-aided diagnoses, which are still in their infancy, would be another option. Patients could try not to express their emotions to the doctor, but that is not always possible when one is suffering or in pain, according to the doctors. (sic, March 22, 2016)