研究顯示:醫生更容易誤診那些混蛋患者

Going to see the doctor can bring out the worst in people. Being sick and fitting an appointment into an overcrowded schedule can be stressful. So can a long sit in the colorless cube of a waiting room.

看醫生常常會讓人感覺很糟，生病或繁忙的日程帶給人很大的壓力，還要長時間坐在沒有顏色的候診室中。

But if you've ever given a doctor attitude, next time you might want to think twice — or risk being misdiagnosed.

但如果你曾經對醫生耍臉色，下次你可要三思了，否則會有被誤診的風險。

That's the implication of two new studies published in the journal BMJ Quality & Safety. Separately, the authors demonstrated that clinicians are more likely to make errors of judgment when they're treating frustrating and difficult patients.

《BMJ Quality Safety》上發表了兩篇研究這個問題的論文。作者指出，在治療令人感到沮喪或不隨和的患者時，臨牀醫生更有可能誤診。

In the first study, the researchers asked 63 family medicine residents at the Erasmus Medical Center in Rotterdam, Netherlands, to read through one of two versions of six patient cases: One version involved a difficult patient; the other, a patient with an identical health issue but a more neutral attitude. (The "difficult" patients were described as being demanding or aggressive, or even questioning their doctor's credentials.)

在第一項研究中，研究人員詢問了63名荷蘭鹿特丹Erasmus醫學中心的家庭醫生，閱讀了6名患者兩種不同版本的病例：一個版本的病人十分不友好，而另一個版本的病人擁有相同的健康問題，但卻保持着相對友好的態度。(不友好的病人指的是提出更多要求、更激進或者質疑醫生的診斷)。

The authors found that even when the medical issues were identical, the doctors provided less accurate diagnoses when faced with disruptive patients. And the effects weren't small. When the patients' medical problems were complex, the doctors made 42 percent more mistakes diagnosing difficult patients compared with more agreeable ones. Among simpler cases, they made 6 percent more errors with troublesome patients compared with neutral ones.

研究人員發現，在遇到相同病情的病人時，醫生給那些不隨和的病人的診斷更加不準確。這個影響非常的大。當病人的病情十分複雜時，不隨和的病人的誤診率比一般病人高出42%，而病情較簡單的病人，出現差錯的概率也多出了6%。

In a second study, 74 hospital doctors (also in the Netherlands) were asked to come up with diagnoses for eight clinical vignettes. Again, half involved difficult patients and the other half more agreeable types. Afterward, the doctors were asked for their diagnoses and to recall clinical and behavioral details about the patients.

在第二項研究中，74名住院醫生被要求對8名病人進行診斷。同樣的，這8名病人中有一半是難搞的病人，另一半則隨和的多。之後，醫生被要求寫出病例，並回憶病人就診時候的行爲細節。

Here, too, diagnostic accuracy was 20 percent lower for the annoying patients, even though time spent on diagnosis was the same. The doctors also tended to recall more about the behaviors of difficult patients, forgetting their clinical histories.

這一次，惱人的患者診斷準確率降低了20%。醫生也更容易回憶起那些不隨和的患者的行爲，而忘記他們的病例。

The researchers suspected physicians' mental resources are so taxed from thinking about how to deal with tricky patients that their ability to process medical information becomes impaired.

研究人員懷疑，醫生要花很多精力思考如何搞定難對付的病人，以致於他們處理醫學信息的能力下降。

An editorial related to the studies pointed out that other research has come to similar conclusions about subpar medical treatment of rude patients, and warned doctors to be aware of the problem. Simple self-reflection might help. For example, "patients with negative behaviors sometimes elicit urges in the physician to interrupt the dialogue, and recognizing this feeling can be a signal to consider a missed diagnosis."

與這項研究有關的一篇評論也曾得出相似的結論，並且提醒醫生要注意這個問題。簡單的自我反省或許會有幫助，例如，“患者的負面行爲有時可能會打斷醫生的診斷，如果醫生意識到患者的這個行爲，或許能夠自我反省診斷是否有誤。”

From the patient perspective, leaving any attitude outside the doctor's office is probably a good idea, lest you risk being misdiagnosed.

從患者的角度來看，將各種找茬行爲留在醫生辦公室外或許是一個好主意，這就避免了被誤診的風險。