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51 How behavioural interactions with the patient affects overdiagnosing – and how to prevent it
  1. Olle Wadström1,
  2. Ann-Marie Skarstam2
  1. 1Psykologinsats, Linköping, Sweden
  2. 2Adult Psychiatry, Malmö, Sweden


There are several reasons for overdiagnosing. In this lecture we focus on the interaction between the doctor and the patient and how that might lead to a diagnose that otherwise would not be clinically warranted.

One example is how the slightly aggressive/demanding or very help-seeking patient affects the scope and outcome of the examination. The doctor may give in, due to a feeling of being ‘forced’ or a wish to be helpful; ‘to do something’. Both can lead to prescription of unnecessary or even inappropriate medication, sick leave, a referral for an examination or giving a clinically irrelevant or incorrect diagnosis.

These interactions between doctor and patient may affect future doctor-patient meetings – the patient might ‘learn’ (consciously or unconsciously) that being forceful, helpless, or threatening gives them the outcome they want and might exert this even more strongly in their next meeting -with the same or a different doctor. And a doctor might learn to be more lenient in prescription/diagnosis in meetings with other patients.

Furthermore, this will have an impact upon the doctor’s well-being and sustainability in the profession. Demands from patients that you can’t fulfill according to your clinical experience and/or evidence-based practice can lead to a feeling of fatigue and helplessness.

Cognitive and motor behaviors are learned due to reinforcements – positive or negative. It is always tempting to let an immediate reinforcer (= relieve of any kind of experienced pressure/discomfort) guide our behavior at the expense of long-term future goals for both the doctor and the patient. The patient achieving better health, and the professional feeling confident in the given treatment – and in the interaction with the patient.

Applied behaviour analysis (ABA) is a tool that can be used to better understand the doctor-patient interaction. It can also predict with great probability what will happen in similar situations in the future. This presentation will highlight and discuss how we as doctors can be more mindful of how these behavioural interactions affect us as doctors – and how we can take charge.

By profession we hold very strong reinforcers (rewards) in our hands and our patient´s behavior might present reinforcers for the doctor to give them what they want or what they feel they need. Just to get a diagnose, or give one, can be a very powerful reinforcement.

The presentation includes an introduction to ABA, patient cases and a discussion with the audience.

Objectives To understand applied behaviour analysis as a tool to work with and use in the interaction with patients.

Method Presentation as a introduction to ABA (Applied Behavioural Analysis), patient cases and a discussion with the audience.

Results To understand how to reduce overdiagnosing due to personal stress reactions.

Conclusions Body and Mind are intertwined, reaction to stress will have an impact on our decisions.

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