Diagnostic uncertainty: from education to communication

Abstract

Diagnostic uncertainty is common in clinical practice and affects both providers and patients on a daily basis. Yet, a unifying model describing uncertainty and identifying the best practices for how to teach about and discuss this issue with trainees and patients is lacking. In this paper, we explore the intersection of uncertainty and expertise. We propose a 2 × 2 model of diagnostic accuracy and certainty that can be used in discussions with trainees, outline an approach to communicating diagnostic uncertainty with patients, and advocate for teaching trainees how to hold such conversations with patients.

Managing Uncertainty During the Communication of Diagnostic Test Information Between Patients and Clinicians in Australian Emergency Care

“…Our findings therefore suggest that a focus on clinical guidelines and education to improve individual clinician skills in uncertainty management or the communication of diagnostic uncertainty (Rising et al, 2018;Santhosh et al, 2019) may disproportionately emphasize modifying the communication behaviors of individual clinicians without addressing or even understanding the pressures that currently drive communication at a systemic level. Indeed, "simple standardised communication interventions to improve quality of care may be ineffective if no account is taken of the particular communication context or organisational culture" (Jones & Watson, 2012, p. 418).…”

“…Uncertainty is thus a multifaceted and deeply pervasive construct with far-reaching implications for patient safety, satisfaction, and care. It is therefore crucial to advance our theoretical understanding of uncertainty (Rains & Tukachinsky, 2015) to guide both the study and practice of safe uncertainty management during the clinical encounter of the diagnostic process (Santhosh et al, 2019).…”

“…This negative conceptualization of uncertainty has also been linked to a broader cultural intolerance of uncertainty in medicine, diagnosis, and health care which may need to be overturned (Simpkin & Schwartzstein, 2016) as it can lead to maladaptive responses to uncertainty with potentially detrimental implications for patients, clinicians, and the health care system (Alam et al, 2017). For example, diagnostic error could occur as a consequence of “diagnostic hubris” when a clinician is “inaccurate but certain” and closes prematurely (Santhosh et al, 2019). Alternatively, excessive pursuit of certainty during the diagnostic process can lead to higher health care costs from low value resource use, such as over-ordering tests (Tsiga & Panagopoulou, 2014).…”

“…Although there is an increasing recognition of the need for such recommendations in clinical guidelines (Santhosh et al, 2019) and education (Rising et al, 2018), empirical work in medical and health services research is currently limited (Alam et al, 2017) and has focussed on clinician rather than patient perspectives (Hillen et al, 2017). It has also occurred largely in isolation from the scattered but more mature and theoretically sophisticated work concerning uncertainty management and communication within the social sciences (Hillen et al, 2017).…”

Face à l’incertitude : humilité, curiosité et partage

“…La présentation quelque peu statique d'une taxonomie ne doit néanmoins pas faire oublier les aspects dynamiques, notamment les interactions entre le niveau d'incertitude objective et la perception subjective de cette incertitude. Ces aspects sont surtout décrits pour l'incertitude diagnostique, alors que les aspects pronostiques ne devraient également pas être oubliés dans cette analyse [14,15].…”