Disruptive, Aggressive Patients May Receive Worse Care

HealthDay News — Disruptive patients may distract physicians and in turn get worse care, according to a study published in BMJ Quality & Safety

The researchers created vignettes about “neutral” patients and “disruptive” patients who do things such as make frequent demands, ignore the doctor’s advice, and act helpless. Then they asked physicians to diagnose the patients.

In one study of 63 family medicine physicians from Rotterdam, 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. The other study, which included 74 internal medicine residents, produced similar findings: In cases considered to be moderately complex, “doctors made 20% more mistakes in difficult compared to neutral patients,” Silvia Mamede, MD, PhD, who worked on both studies, told HealthDay. Dr Mamede is an associate professor with the Institute of Medical Education Research Rotterdam at Erasmus Medical Center in the Netherlands.

“Patients who behave disruptively by displaying disrespect or aggressiveness may induce their doctors to make diagnostic mistakes,” Dr Mamede said


  1. Schmidt HG, Van gog T, Ce schuit S, et al. Do patients’ disruptive behaviours influence the accuracy of a doctor’s diagnosis? A randomised experiment. BMJ Qual Saf. 2016; doi:10.1136/bmjqs-2015-004109.
  2. Mamede S, Van gog T, Schuit SC, et al. Why patients’ disruptive behaviours impair diagnostic reasoning: a randomised experiment. BMJ Qual Saf. 2016; doi:10.1136/bmjqs-2015-005065.