Author Interviews, BMJ / 06.07.2016

MedicalResearch.com Interview with: Professor Tom Bourne Ph.D., FRCOG, FAIUM (hon). Adjunct Professor, Imperial College, London Visiting Professor, KU Leuven, Belgium Consultant Gynaecologist Queen Charlotte's and Chelsea Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous studies had suggested that complaint investigations might be associated with psychiatric morbidity – including depression and suicide. For example in the United States, malpractice litigation has been reported to be associated with burnout, depression and suicidal ideation. We had also witnessed in our daily practice both the burden that complaints investigations have on colleagues, but also that doctors were often practicing defensive medicine to “protect themselves”. Against this background we embarked on a large survey study on doctors in the UK – with almost 8000 physicians replying to the survey. This survey contained questions relating to validated psychological instruments for depression and anxiety, new metrics for defensive practice (hedging and avoidance) as well as single item questions. We published these data in 20151. We found that recent or current complaints were associated with significant levels or anxiety, depression and suicidal ideation, this was irrespective of the complaints procedure – although this was highest when it involved the main UK regulator the general medical council (GMC). Many doctors reported practising defensive medicine due to a fear of complaints – with over 80% reporting hedging and over 40% reporting avoidance. A number of recommendations were made to improve how complaints procedures might work. In the final part of the questionnaire we asked three open questions, how the complaints procedure made the doctor feel, what was the most stressful aspects of the procedure and what could be done to improve things. It is the analysis of this qualitative data that is presented in the current paper. (more…)
Author Interviews, BMJ / 15.03.2016

MedicalResearch.com Interview with: Sílvia Mamede, MD, PhD Associate professor Institute of Medical Education Research Rotterdam Erasmus MC Rotterdam, The Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Mamede: Doctors are often engaged in clinical encounters that are emotionally charged. Patients who feel anxious about their problems often respond emotionally in their interaction with their doctors. Most of these encounters fall within the limits of what is to be expected in clinical practice, but some patients behave in ways that make the doctor-patient interaction particularly distressing. Aggressive or disrespectful patients, frequent demanders, patients who don’t trust their doctors’ competence or ever-helpless patients are known, in the medical literature, as “difficult patients”. Doctors have reported to encounter these so-called “difficult patients” in around 15% of the outpatient consultations. As it might be expected, these patients’ behaviors provoke emotional reactions in doctors. The potential negative effect of these reactions on the doctor’s diagnostic accuracy has long been discussed in the medical literature. However, there was no empirical evidence that this happened. We conducted two studies to fill this gap. In the two studies, doctors diagnosed clinical cases that were exactly the same except for the patient’s behaviors. In the first study, we used complex and simple cases. Even though the cases were the same, doctors made 42% more mistakes in disruptive than in non-disruptive patients when the cases were complex, and 6% more mistakes when the cases were simple. In the second study, we used cases deemed to be at an intermediate level of complexity. Doctors made 20% more mistakes in difficult compared to neutral patients. These findings show that disruptive behaviors displayed by patients seem to affect doctors’ reasoning and induce them to make diagnostic errors. The findings of our second study suggest that disruptive behaviors “capture” the doctor’s attention at the expense of attention for the clinically relevant information. We came to this conclusion because when asked to recall the information from a case afterwards, doctors who were confronted with a difficult patient remember more information about the patient’s behaviors and less information of the clinically relevant symptoms than doctors confronted with the natural version of the same patient. Recall of information is considered a measure of the amount of attention given to such information. (more…)
Author Interviews, Social Issues / 27.08.2015

Juliana Schroeder PhD, Assistant Professor Berkeley Haas Management of Organizations Group University of California at BerkeleyMedicalResearch.com Interview with: Juliana Schroeder PhD, Assistant Professor Berkeley Haas Management of Organizations Group University of California at Berkeley Medical Research: What is the background for this study? What are the main findings? Dr. Schroeder: Whereas much research examines how physicians perceive their patients,in this paper we instead study how patients perceive physicians. We propose that patients consider their physicians like personally emotionless “empty vessels:” The higher is individuals’ need for care, the less they value physicians’ traits related to physicians' personal lives (e.g., self-focused emotions) but the more they value physicians’ traits relevant to patient care (e.g., patient-focused emotions). ​In a series of experiments,we show that participants in higher need for care believe their physicians have less personal emotions. That is, they perceive physicians as emotionally "empty" the more they need them. This was true both when we manipulated need for care - for example, by having participants focus on potential medical problems or reminding them they needed to get a medical check-up - and also when we measured it, for example by comparing patients at a medical clinic (high need) to people not at a clinic (low need). (more…)