Choice of words might matter when doctors communicate uncertainty of diagnosis to their patients. A paper published in the International Journal for Quality in Health Care shows that parents of pediatric patients may react more negatively to doctors who communicate uncertainty of diagnosis explicitly, such as directly stating they are unsure, as compared to doctors who use implicit language, such as discussing “most likely” diagnosis or providing several possible diagnoses under consideration.
“Misdiagnosis is common in medical practice and to enable improvements, uncertainty of diagnosis is something both doctors and patients will need to embrace,” said senior author Dr. Hardeep Singh, associate professor of medicine at Baylor College of Medicine and researcher at the Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety. “Our study provides a foundation for future development of evidence-based guidance on how doctors can best communicate diagnostic uncertainty to patients to improve diagnosis and care outcomes.”
Diagnostic uncertainty is widespread in clinical practice, and guidelines generally recommend that doctors explain the degree of uncertainty associated with their diagnosis. However, how exactly doctors should communicate uncertainty is a matter of debate. This communication can possibly lower visit satisfaction, decrease adherence to doctor instructions, lessen trust and decrease confidence in the doctor.
The researchers here surveyed parents of pediatric patients who hypothetically received a diagnosis with an element of uncertainty. The uncertainty in the diagnosis was communicated in one of three ways: either with an explicit expression of uncertainty (such as “I’m not sure which disease this is”), an implicit expression of uncertainty using broad differential diagnoses (such as “it could be this disease or this other disease”) or another implicit expression of uncertainty (such as “it is most likely this disease”).
Researchers found that explicit expressions of uncertainty were associated with lower perceived technical competence of the doctor, less trust and confidence and less willingness to adhere to doctors’ advice.
Other contributors to this work include Dr. Viraj Bhise, Dr. Ashley N.D. Meyer, Dr. Shailaja Menon, Dr. Geeta Singhal, Dr. Richard Street Jr., Dr. Traber Giardina. The researchers are affiliated with one or more of the following institutions: Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston Community College, Texas Children’s Hospital, and Texas A&M University.
This study was funded by the VA Health Services Research and Development Service (CRE12-033; Presidential Early Career Award for Scientists and Engineers USA 14-274), the VA National Center for Patient Safety and the Agency for HealthCare Research and Quality (R01HS022087 and R21HS023602). This work was supported in part by the Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (CIN13-413).