Threats from patients and their effects on medical decision making: a cross-sectional, randomised trial

Background Negative experiences are not uncommon among doctors in Norway. O ur aim was to find out about the various types of negative reactions (eg, c omplaints, negative exposure to the media, financial claims, and notificati on to the police) received by physicians from patients or relatives in resp onse to treatment, to identify their cause, and to study their effects on s ubsequent clinical decisions. Methods We posted questionnaires about negative reactions of patients to a random sample (n=1260) of Norwegian doctors. Each doctor was additionally s ent five written case simulations and asked to choose one of several propos ed clinical strategies. Half (630) the physicians received cases containing threats from the patient or their relatives. Findings 988 (78%) physicians returned the questionnaire, 463 (47%) of whom reported negative experiences. Such experiences were reported more frequen tly by men (357 [51%]) and family physicians (157 [58%]) than by other part icipants. Negative experiences did not affect choice of strategy for case s imulations. For the first case, chest pain, 217 (44%) physicians presented with a threat chose a defensive strategy compared with 145 (30%) of those w ho were not (difference 14%: 95% CI 8-20). For the second case, a headache case, the corresponding numbers were 278 (57%) and 118 (25%) (32%; 26-38). Physician age. sex, specialty, or experience of negative reactions of patie nts did not alter the effect of threats received during our study. Interpretation Negative experiences do not affect subsequent decision makin g. However, doctors do comply with wishes from patients or relatives when p resented with direct threats.