研究显示:医生更容易误诊那些混蛋患者
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.
看医生常常会让人感觉很糟，生病或繁忙的日程带给人很大的压力，还要长时间坐在没有颜色的候诊室中。But if you've ever given a doctor attitude, next time you might want to think twice — or risk being misdiagnosed.
但如果你曾经对医生耍脸色，下次你可要三思了，否则会有被误诊的风险。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》上发表了两篇研究这个问题的论文。作者指出，在治疗令人感到沮丧或不随和的患者时，临床医生更有可能误诊。
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.)
在第一项研究中，研究人员询问了63名荷兰鹿特丹Erasmus医学中心的家庭医生，阅读了6名患者两种不同版本的病例：一个版本的病人十分不友好，而另一个版本的病人拥有相同的健康问题，但却保持着相对友好的态度。(不友好的病人指的是提出更多要求、更激进或者质疑医生的诊断)。
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.
研究人员发现，在遇到相同病情的病人时，医生给那些不随和的病人的诊断更加不准确。这个影响非常的大。当病人的病情十分复杂时，不随和的病人的误诊率比一般病人高出42%，而病情较简单的病人，出现差错的概率也多出了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.
在第二项研究中，74名住院医生被要求对8名病人进行诊断。同样的，这8名病人中有一半是难搞的病人，另一半则随和的多。之后，医生被要求写出病例，并回忆病人就诊时候的行为细节。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.
这一次，恼人的患者诊断准确率降低了20%。医生也更容易回忆起那些不随和的患者的行为，而忘记他们的病例。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.
研究人员怀疑，医生要花很多精力思考如何搞定难对付的病人，以致于他们处理医学信息的能力下降。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."
与这项研究有关的一篇评论也曾得出相似的结论，并且提醒医生要注意这个问题。简单的自我反省或许会有帮助，例如，“患者的负面行为有时可能会打断医生的诊断，如果医生意识到患者的这个行为，或许能够自我反省诊断是否有误。”From the patient perspective, leaving any attitude outside the doctor's office is probably a good idea, lest you risk being misdiagnosed.
从患者的角度来看，将各种找茬行为留在医生办公室外或许是一个好主意，这就避免了被误诊的风险。
