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Patients react better when doctors imply uncertainty, rather than state it directly

Oxford University Press USA

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 the 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.

Diagnostic uncertainty is widespread in clinical practice and physician 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 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 a less willingness to adhere to doctors' advice.

"Misdiagnosis is common in medical practice and to enable improvements, uncertainty of diagnosis is something both doctors and patients will need to embrace" said Hardeep Singh, MD, MPH, senior author and researcher at the Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety and Baylor College of Medicine. "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."


The paper "Patient Perspectives on How Physicians Communicate Diagnostic Uncertainty: An Experimental Vignette Study" is available at:

Direct correspondence to: Hardeep Singh, MD MPH

To request a copy of the study, please contact:

Daniel Luzer

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