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…)