Do No Harm: When Not Listening Leads to the Wrong Diagnosis

Charles P. Vega, MD


November 27, 2018

Hello. I'm Dr Charles Vega, and I am a clinical professor of family medicine at the University of California at Irvine. Welcome to Medscape Morning Report, our 1-minute news story for primary care.

A recent study[1] set out to learn more about how patient experience and patient-physician interactions affect the risk for diagnostic error.

The nonprofit Empowered Patient Coalition collects reports from patients and families to learn more about safety events from the patient's point of view. Amid the almost 200 examples of diagnostic error analyzed, problems in patient-physician interactions emerged as a major contributing factor. The scenarios described strikingly similar experiences of problematic clinician behaviors.

The most common were reports of clinicians ignoring or dismissing worrisome symptoms or changes in the patient's status, including a failure to improve. Less common, but still reported with disconcerting frequency ,were complaints that physicians disrespected the patient, engaged in manipulation or deceit, or communicated ineffectively.

About two thirds of the narratives were contributed by female patients, and 4 out of 5 of the reported diagnostic errors took place in a hospital. More than half of patients reported the error to the healthcare institution responsible, but only 9% said that they were satisfied with the response.

The paper offers an unvarnished look at the healthcare system from the perspective of patients who had been harmed.

While I doubt that any of us ever intend to be dismissive or patronizing to patients, in the course of endlessly busy days we all may slip into behaviors like those described. This study is a good reminder that not listening can be more than just unkind; it can be downright dangerous.


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