Blog | Wednesday, September 15, 2010

QD: News Every Day--Patients swap doctors rather than discuss their care

Patients won't confront doctors if they think there's been a mistake. They'll just find a new doctor, even if there'd been no medical error.

Researchers looked at adult visits to seven primary care practices in North Carolina during 2008. They asked patients about their perceptions of medical mistakes and how did it influence the choice to switch doctors.

Of 1,697 patients, 265 (15.6%) reported a mistake had been made, 227 (13.4%) reported a wrong diagnosis, 212 (12.5%) reported a wrong treatment, and 239 (14.1%) reported changing doctors as a result. Results appeared in the Archives of Internal Medicine.

But anecdotes cited by patients as mistakes were often normal diagnostic or therapeutic challenges. A typical scenario might be the patient reported symptoms, the doctor did not correctly diagnose it at first presentation, and a specialist or second physician offered a specific diagnosis. Other scenarios included medication trials or side effects from the prescription.

The study's lead author told Reuters that this occurred even when the doctor hadn't done anything medically wrong.

Patients with chronic back pain, more education and poor physical health were more likely to perceive mistakes. Whites were more likely to report mistakes (19.6%) than blacks (13.1%) or Hispanics (13.4%).

And, patients reported more harm as a result of the mistakes than rates of harm reported in the literature, the researchers noted.

Communication and relationship problems or trouble seeing the doctors were reported as mistakes such as a misdiagnosis, according to the study. And, patients frequently reported as mistakes things such as medication trials that doctors consider a normal part of diagnosis and treatment.

Knowing which patients are at increased risk for perceiving mistakes may be useful to doctors so they can temper patients' expectations, study authors wrote. An editorial said, "Some of these may be true mistakes; others may be due to the progression of disease, community-accepted stepwise testing and monitoring of symptoms to reach a diagnosis, well-known medication adverse reactions, and the sensitivity of medical diagnostics," and called for better measures of patient safety in the ambulatory setting.