Only 9% Of Doctors Give Error-Free Care in Complex Cases

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A study at the University of Illinois at Chicago, led by Dr. Saul Weiner, associate professor of medicine and pediatrics and staff physician at Jesse Brown VA Medical Center, discovered a disconcerting trend among physicians: they do not often provide accurate care in complex cases.

The study used actors with scripts to pretend to be patients. The doctors knew they were in the study (having agreed to it) but would not know who was or wasn’t an actor. There were variants to the scripts and types of complexity presented to physicians. The types of physicians were varied and located in Chicago and Milwaukee.

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Basically, there were four variants: uncomplicated, biomedically complex, contextually complex, or both biomedically complex and contextually complex. Biomedically complex would mean more than one physical “red flag” would be present (for example, symptoms of a new disorder when treating/discussing another one). Contextually complex would mean a life event that may impact the patient’s care (such as losing health insurance or prescription drug coverage).

When provided an uncomplicated case, 73% of doctors provided error-free care. With biomedically complex case, only 28% provided accurate care, 22% for contextually complex cases, and a shocking 9% of physicians provided accurate care for both biomedically and contextually complex cases. Another surprising find for researchers was it didn’t matter if the physician had longer time to spend with the patients. Dr. Weiner says “… we found… that among those visits where physicians did a great job identifying contextual issues and addressing them, they did not, on average, spend any more time with patients than the physicians who didn’t recognize contextual issues. That was surprising… The lesson here is that there has to be a dramatic change in the way we train physicians.”

Indeed, patients have been long lamenting the need for more time with their doctors and doctors have agreed. With the way doctor’s reimbursement rates have been cut, the answer has been to double-book patients, leaving less time with each patient. Patients and doctors have assumed that the decrease in accuracy of care (and the lack of a bedside manner) has been a direct result of that practice. However, according to this study, it may not be as helpful to have more time with your doctor than one might think.

Doctors do well when following protocols for uncomplicated cases but obviously they need to pay attention when new information comes to light. If a patient complains of increased coughing at night (a sign of acid reflux, for example) when the patient has COPD, a doctor should address it as a possible symptom of something else and not just assume it is part of the current diagnosis. If a patient has an increase in pain in a specific area, the doctor should not just assume it is part of a general chronic pain issue (such as fibromyalgia). If doctors are given more time, they need further training in exploring both contextual complexities as well as biomedical complexities. Having more time to address the issues facing patients will be no good if doctors do not take advantage of it appropriately.

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