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Patient Threats May Affect Docs' Treatment Choices

Friday April 20, 2001

NEW YORK (Reuters Health) - Dissatisfied patients who threaten their doctor with negative publicity or plans to file a complaint can affect their course of treatment, a new study suggests.

Among nearly 1,000 Norwegian doctors surveyed, 59% had been threatened and 47% had actually had complaints filed against them or other negative experiences. While these past experiences did not influence their decisions on how to proceed with simulated cases, the results suggest, current patient threats may succeed in changing the course of treatment.

According to the report, 44% of physicians chose a defensive strategy when presented with a simulated case in which relatives of a patient with chest pain threatened to go to the press if a doctor did not order further tests. Among doctors who received the same scenario, without the threat, 30% chose a defensive strategy. Defensive medicine, the researchers explain, means ordering tests and treatments to guard against criticism rather than to diagnose or treat the patient.

Similarly, 57% of doctors chose a more defensive approach for a patient with severe headaches who threatened to file a formal complaint to the county medical officer if not referred to a neurologist, compared with 25% of doctors who were not threatened.

While conceding that further tests can be useful, the researchers note that patients' wishes ``could lead to unreasonable use of resources in a system where health care is not paid for directly by the patient. Also, increased use of diagnostic tests can lead to a high proportion of false-positive results if the probability of disease is low,"" explain Dr. IvarSonbo Kristiansen of the University of Southern Denmark in Odense and colleagues.

In the survey, doctors were presented with five hypothetical situations and asked to choose among several proposed management strategies. Half of the doctors received cases in which patients or their relatives made threats.

SOURCE: The Lancet 2001;357:1258-1261.


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