How criticising doctors can increase the risk of medical errors

20170123150000, Zayani Bhatt
Engaging with doctors calmly can help reduce the risk of medical errors.
Engaging with doctors calmly can help reduce the risk of medical errors.
Emotions tend to run high in hospitals and can cause patients’ loved ones to be critical towards medical professionals when they perceive inadequate care.

Research carried out by University of Florida management professor Amir Erez and doctoral student Trevor Foulk at the Neonatal Intensive Care Unit (NICU), in an Israeli hospital, has uncovered the extent to which disagreeable comments can affect the care a doctor is able to deliver.

Doctors not immune to the negative mental effects of criticism

Medical teams which included two doctors and two nurses each, were given infant medical mannequins to treat over the course of a day, with emergency situations such as respiratory distress and hypovolemic shock. An actress playing the mother would then berate some of the teams, with comments such as “I know we should have gone to a better hospital” and accusations of the doctors providing “third-world care”.

The control groups were not disparaged and every team’s performance was measured using 11 parameters including, time to diagnose, accuracy of diagnosis, teamwork and communication and treatment planning.

The results showed that those who were faced with the argumentative mother underperformed in all measures. The effects of criticism accounted for 40% of the variance of practitioner performance whereas lack of sleep only accounted for 20%.

“People may think that doctors should just ‘get over’ the insult and continue doing their job. [Rudeness] is actually affecting the cognitive system, which directly affects your ability to perform,” Erez said.

Next step: Helping doctors to cope with criticism

The results “could potentially save lives” and pave the way in finding new methods to help doctor’s cope with derision. Erez and his team also investigated two different methods of intervention for the non-control teams.

Certain teams were given a pre-test intervention, in which doctors were provided with a computer game that desensitised them to strong emotions; otherwise known as cognitive bias modification. Other teams were given a post-test intervention in which they were asked to write about the experience from the point of view of the harrowed mother.

Erez found no difference in the performance between the control groups and those teams who received pre-test intervention.

“It’s really shocking how well it worked,” Erez said. “They were basically immunised from the effects of rudeness.”

Another study conducted by researchers from Erasmus University, Erasumus Medical Center, and Admiraal de Ruyter Hospital, all in The Netherlands, with 60 young doctors acquired the same results. The doctors were given six hypothetical scenarios in a booklet and each reflected an archetypal difficult patient.

By asking the doctors to diagnose and rate the likability of each patient, the researchers found that the more difficult a patient, the more likely the doctor was to make a mistake.

Re-adjusting bias and de-sensitising to hurtful words can help

In a follow-up study, the scientists further examined this connection and concluded that dealing with aggressive patients drained doctors of the mental energy required to make accurate clinical rulings. Additionally, some patients triggered reactions in doctors that hampered with their judgement and reasoning skills. Disruptive behaviour is powerful because it can disturb an individual’s working memory, which in turn affects the ability to learn, recall and apply information in the moment.

This is troublesome especially as a study conducted in 2010 suggested that this behaviour is very common – in fact nearly two-thirds of operating room staff have had to deal with it. The best solution to this would be patients being more mindful but high anxiety and stressful situations can make even the best act out. Doctors may therefore be better equipped by learning to recognise when a patient is negatively affecting a situation, as soon as possible.

Another trick is meta-cognitive de-biasing or the ability to reimage a difficult patient behaving in a more pleasant manner. Converging with colleagues and asking for advice can help doctors feel less alone and reminding patients that they can express concerns in a more amiable manner, can help reduce tensions on both sides.

In the meantime, hopefully researchers can develop more techniques like playing computer games to aid doctors in dealing with the many quagmires of the medical profession. MIMS

Read more:
The influence of word choices in patient-doctor communications
The patient’s differential treatment of nurses and doctors
Dismissive behaviour: A threat to a doctor’s workplace and career

Sources:
http://www.theage.com.au/victoria/criticising-doctors-and-nurses-causes-medical-errors-20170117-gtt82r.html
http://www.newser.com/story/236918/rude-to-your-kids-doctor-think-again.html
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http://pediatrics.aappublications.org/content/early/2017/01/06/peds.2016-2305?
http://nymag.com/scienceofus/2015/10/rudeness-in-hospitals-could-kill-patients.html
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