Effective communication is necessary for diagnostic quality, as described by the National Academy of Medicine Committee on Diagnostic Errors in Healthcare. During clinical visits, communicating diagnostic uncertainty to patients is a crucial part of meaningful diagnostic communication and decreasing diagnostic errors. Unfortunately, there is a scarcity of studies and interventions addressing the optimal management of this crucial aspect of communicating with patients about diagnostic uncertainty.
The current state of diagnostic uncertainty management is both underdeveloped and controversial. Some have stated that the lack of direct expressions of uncertainty or indirect displays of inadequate knowledge is indicative of a clinician’s inability to admit ambiguity. The medical curriculum provides little direction on how to develop communication skills that effectively convey ambiguity.
Many think that when professionals’ express hesitation, patients may regard them as less knowledgeable, confident, or competent. Nonetheless, improper management of diagnostic uncertainty may lead to diagnostic delays (if patients are wrongly comforted and may not recognize the need to examine alternate diagnoses) or unneeded anxiety (if non-reassuring communication overly worries them). Increasing data and ethical standards that respect patient autonomy indicate that recognizing diagnostic ambiguity has potential benefits, such as enhancing and fostering clinician-patient relationships and trust, enabling improved patient engagement, and furthering shared decision-making.
Patients who seek reassurance (there is nothing serious) or a definitive explanation (your diagnosis is X) from clinicians are unlikely to appreciate equivocal, vague, hedged, or evasive responses from physicians who lack confidence, knowledge, and certainty. Yet, sincerity and openness require that clinicians abandon their arrogant overconfidence and frankly and truthfully admit what they do and do not know about the diagnosis. This transparency is essential for enabling collaborative decision-making and guaranteeing safe action plans, monitoring, and follow-up.
Handling diagnostic uncertainty and engaging in candid talks about ambiguous diagnoses can promote a patient-centered approach, facilitate shared decision-making, and enhance the reliability and safety of follow-up care. PCPs and patients stressed the necessity of incorporating diagnostic ambiguity into clinical encounter dialogues and workflow in research published in JAMA Network Open. Historically, physicians have rarely discussed diagnostic doubt due to time restrictions of clinical encounters, workloads, lack of experience, and reluctance to share their uncertainties.
Prior research rarely examined methods that may be effective for clinicians to communicate diagnostic uncertainty in a manner that respects workflow constraints, captures the patient-clinician conversation, and is patient-centered, such as assisting patients in recall and involving them in treatment decision-making. According to the knowledge of the researcher, this is the first study to focus on defining guidelines for expressing diagnostic uncertainty to patients and examining strategies to practically integrate dialogues about uncertainty into the workflow.
The study developed recommendations for best practices to manage and communicate uncertainty and iteratively developed and implemented an innovative communication tool for incorporating uncertainty language into a patient leaflet that can be captured using voice recognition technology during the encounter. Based on the themes that arose from the literature analysis, interviews with informatics specialists and experienced PCPs (think-aloud scenario testing), and a series of focus groups and patient interviews, the tool was built.
It was created to assist doctors in managing diagnostic uncertainty, appropriately documenting the encounter, and serving as a safety net for educating patients about recommended testing, monitoring, and treatments. The doctors who used the tool during the clinical visit also found that it reminded them to mention uncertainty and crucial communication domains. PCPs utilizing the program was, therefore, able to talk with patients while simultaneously dictating their diagnostic assessment via voice-recognition software, generating a printable, patient-friendly, tailored diagnosis handout for the patient.
The recent emphasis on the need of recognizing diagnostic ambiguity is long overdue. Diagnostic uncertainty must be effectively, acceptably, and efficiently integrated into the clinical workflow as it becomes more widely recognized. The study confirmed that enhancing verbal communication with a written patient leaflet may be beneficial for expressing uncertainty messages in a meaningful and dependable manner, with patients highly valuing the option to take home verbally transmitted messages.
This can also be advantageous for people with inadequate health literacy who may struggle to interpret verbal information. If translated into the patient’s primary language, the leaflet could serve as both a reminder and a reference for the material discussed during the consultation. Even if the booklet is only available in English, English-speaking patient family members may be able to review it with the patient.
The 6 structural elements (building blocks) of the leaflet (explaining most likely/differential diagnoses; indicating what to monitor [observation and next steps]; identifying the expected course/improvement and time frames; acknowledging the limitations of examinations and tests; facilitating access to clinicians, including contact information [when to call]; and providing space/mechanism for patients to add thoughts and input) can provide useful information for patients.
Even less-experienced practitioners could benefit from such a tool to reduce diagnostic errors and build patient confidence. Nonetheless, the authors assert that additional study is necessary to investigate the factors that influence clinician decisions to convey diagnostic ambiguity, which may vary by patient, diagnosis, treatment schedule, workload, time restrictions, clinician comfort, and patient preferences.
Given the necessity of addressing a patient’s diagnosis and any associated diagnostic uncertainty with their providers, it is necessary to develop innovative techniques to enhance such communication. The pilot research contributed to the development of a framework for providing essential diagnostic uncertainty information in the form of a customized written summary during clinical encounters. When coproducing a diagnosis, clinicians and patients can benefit from such a structured tool, which can also serve as the foundation for methodically and proactively communicating diagnostic ambiguity.
