There is no patient more difficult for a physician than another physician, or the physician’s family.

The old saying goes that people who have bad outcomes include anyone in the healthcare field- a doctor, a doctor’s significant other, or a nurse.

This came to mind when a recent British Medical Journal noted that difficult patients tend to have less accurate diagnosis made than those patients who are not perceived as difficult. The study has its flaws — diagnosis was made in a two minute time period.  The diagnosis was made correctly 64 per cent of the time with a “non disruptive” patient and 54% of the time with a patient who was considered “disruptive.”  The study involved clinical stories where the diagnosis was the same but the patients presented differently. Each scenario  was presented as a ‘negative’ or a ‘neutral’ version by changing the narrative. The negative version described the patient  as “He is angry about the long waiting time and starts speaking harshly …”. The neutral version described the same patient with h as “He comments on the long waiting time but says he is glad …”.

When those same stories were assigned to different physicians there was a decrease in accuracy of the diagnosis.

Physicians are clearly human, and respond, as all humans to with a full range of emotions. The ability for clinicians to re-focus and ignore the negative “vibes” is something we are taught in medical school, but few are completely successful at it.

While the study was small, and gets a lot of press – it points out how that the development of a relationship between a provider and the patient is critically important for both the physician and the “customer.”