According to new research published in the International Journal for Quality in Health Care, the parents of paediatric patients might 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 research team evaluated the effects of three different strategies for communicating diagnostic uncertainty on patient perceptions of physician competence and visit satisfaction.
The researchers here surveyed parents of paediatric 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 the lower perceived technical competence of the doctor, less trust and confidence, and a less willingness to adhere to doctors' advice.
Hardeep Singh, senior author of the study said, “Misdiagnosis is common in medical practice and to enable improvements, the uncertainty of diagnosis is something both doctors and patients will need to embrace.”
The 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, he added.
In conclusion, the study reported that parents might react less negatively in terms of perceived competence, physician confidence and trust, and intention to adhere when diagnostic uncertainty is communicated using implicit strategies, such as using broad differential diagnoses or most likely diagnoses.