By Evan Falchuk

According to the Annals of Internal Medicine, doctors make the wrong medical decisions surprisingly often.

Using a “mystery patient” technique – in which actors pretended to be patients – researchers found that doctors made errors in complicated cases in 60% to 90% of cases.  Sixty to ninety percent. In uncomplicated cases, they made errors in nearly 30% of cases.

As one study participant put it, “I was shocked.”

The study took place over 3 years, and included more than 100 doctors in six Chicago-area hospitals.  The doctors had agreed to participate in a study on medical decision-making but had no idea that they might see a patient who was actually an actor.  The actors recorded their conversations with the doctors.

The actors used scripted medical situations.  In each case, the actor presented their medical situation, but mentioned “red flags” that should have caused the doctors to pay attention and change their plan of care.  According to the LA Times:

Researchers used the audio recordings and medical records to calculate how often physicians picked up on red flags signifying possible complications and consequently adjusted their plan of care. The failure to do both counted as an error. In contextually complicated encounters, error-free care was provided only 22 percent of the time; in biomedically complicated encounters, the error-free rate was 38 percent.

The researchers called this a “failure to individualize care.”

So what’s going on?

Regular readers here won’t be surprised to hear how one participant explained the failure to pursue these red flags.  Doctors, he said, are under “incredible time pressure and don’t want to go there because it could open up a whole can of worms.”  There’s likely a lot to this explanation. It’s hard to expect even the most gifted clinician, trying to make it through yet another week of a hundred or more patient encounters, to get these difficult decisions right.  Too much of the context of a patient’s care gets lost in the endless churn of patient visits that the health care system imposes on doctors.

I suspect this is enormously frustrating for doctors, although it’s worse for patients.  What the researchers call a failure to “individualize care,” a patient might call “not being paid attention to.”  It’s a dynamic that anyone who’s been ill has probably seen first-hand.

As policymakers talk about comparative effectiveness and electronic medical records and all the rest, they keep repeating the same mistake that brought us to this point.  They fail to understand that doctors need time – time to think, time to reflect, time to consult on their patient’s case.  Time to sit with the patient, time to understand their situation, time to help them make the best decisions.  Time to use their intellect and their training.  Time to make clear to their patient the truth:  that they care, and are here to help.

And so until the time comes when we place the relationship between doctor and patient at the center of everything we do in health care, we’ll continue to see tragic results like those found in this remarkable study.