BACKGROUND Frequent and repeated visits from patients with mental illness or free medical care recipients may elicit physicians' negative emotions and influence their clinical decision making. This study investigated the impact of the psychiatric or social background of such patients on physicians' decision making about whether to offer recommendations for further examinations and whether they expressed an appropriate disposition toward the patient. METHODS A randomized, controlled multi-centre study of residents in transitional, internal medicine, or emergency medicine was conducted in five hospitals. Upon randomization, participants were stratified by gender and postgraduate year, and they were allocated to scenario set 1 or 2. They answered questions pertaining to decision-making based on eight clinical vignettes. Half of the eight vignettes presented to scenario set 1 included additional patient information, such as that the patient had a past medical history of schizophrenia or that the patient was a recipient of free care who made frequent visits to the doctor (biased vignettes). The other half included no additional information (neutral vignettes). For scenario set 2, the four biased vignettes presented to scenario set 1 were neutralized, and the four neutral vignettes were rendered biased by providing additional information. After reading, participants answered decision-making questions regarding diagnostic examination, interventions, or patient disposition. The primary analysis was a repeated-measures ANOVA on the mean management accuracy score, with patient background information as a within-subject factor (no bias, free care recipients, or history of schizophrenia). RESULTS A total of 207 questionnaires were collected. Repeated-measures ANOVA showed that additional background information had influence on mean accuracy score (F(7, 206) = 13.84, p <  0.001 partial η2 = 0.063). Post hoc pairwise multiple comparison test, Sidak test, showed a significant difference between schizophrenia and no bias condition (p <  0.05). The ratings for patient likability were lower in the biased vignettes compared to the neutral vignettes, which was associated with the lower utilization of medical resources by the physicians. CONCLUSIONS Additional background information on past medical history of schizophrenia increased physicians' mistakes in decision making. Patients' psychiatric backgrounds should not bias physicians' decision-making. Based on these findings, physicians are recommended to avoid being influenced by medically unrelated information.

中文翻译：

---

精神病学或社会背景对临床决策的影响：一项随机，对照的多中心研究。

背景技术患有精神疾病的患者或免费的医疗接受者的频繁且反复的拜访可能引起医师的负面情绪并影响他们的临床决策。这项研究调查了此类患者的精神病学或社会背景对医生决定是否提供进一步检查的建议以及他们是否对患者表现出适当态度的决定的影响。方法在五家医院对过渡，内科或急诊科住院医师进行了一项随机，对照的多中心研究。随机分组后，按照性别和研究生年份对参与者进行分层，然后将他们分配给场景1或2。他们根据8个临床插曲回答了与决策有关的问题。呈现给场景1的八个小插曲中有一半包含其他患者信息，例如该患者有精神分裂症的既往病史，或者该患者是接受免费护理的患者，他经常拜访医生（有偏见的小插曲）。另一半不包含任何其他信息（中性渐晕）。对于方案集2，提供给方案集1的四个有偏见的小插图被中和，并且通过提供其他信息使四个中立的小插图有偏见。阅读后，参与者回答了有关诊断检查，干预措施或患者处置的决策问题。初步分析是对平均管理准确性评分进行重复测量的ANOVA，将患者背景信息作为受试者内部因素（无偏见，免费护理接受者，或精神分裂症的病史）。结果共收集了207份问卷。重复测量方差分析表明，其他背景信息对平均准确度得分有影响（F（7，206）= 13.84，p <0.001部分η2= 0.063）。事后成对多重比较试验，Sidak检验显示，精神分裂症和无偏倚条件之间存在显着差异（p <0.05）。与中性小插图相比，有偏见的小插图对患者的喜好度较低，这与医师对医疗资源的利用较低有关。结论有关精神分裂症既往病史的其他背景信息增加了医师在决策中的错误。患者的精神病学背景不应使医师的决策产生偏差。根据这些发现，