New ICH research on diagnostic uncertainty: What do doctors do and say when they are unsure about a diagnosis?

New ICH research on diagnostic uncertainty: What do doctors do and say when they are unsure about a diagnosis?
Wednesday 5 October 2022

A new study, ‘Communication of Diagnostic Uncertainty in Primary Care and Its Impact on Patient Experience: an Integrative Systematic Review’ in the Journal for General Internal Medicine, highlights not only the communication strategies that doctors use when they are uncertain about a diagnosis, but also provides a catalogue of what they say for the first time.

Together with their team, lead authors Dr Mary Dahm (Senior Research Fellow, ANU Institute for Communication in Health Care) and William Cattanach (ANU medical student) conducted an integrative systematic literature review to investigate how primary care doctors communicate diagnostic uncertainty in interactions with patients and how patients experience their care in the face of uncertainty.

“We found that doctors used two main communication strategies to manage diagnostic uncertainty,” explained health communication researcher Dr Mary Dahm.

“Doctors used patient-centred communication strategies, for example they reassured patients, or they used strategies related to diagnostic reasoning, for example when they exclude serious diagnoses.”

Dr Dahm explained that doctor also say different things when they are uncertain. 

“One way doctors sharing their uncertainty is by making a very obvious negative statement such as ‘‘I don’t know’. But doctors also use more ‘hidden’ ways of saying they are uncertain or don’t tell patients it at all.”

Patients’ experiences of care in response to the diverse communicative and linguistic strategies were mixed. “However, in the face of uncertainty,” Dr Dahm elaborated, “communication that is more holistically focused on the patient as a person, and not just a clinical problem, was generally regarded positively by patients.”

Dr Dahm also highlighted that the most common symptoms associated with expressing diagnostic uncertainty in primary care were fever, chest pain and abdominal pain. “These are symptoms all of us have experienced but that can in rare cases can be misdiagnosed with devastating consequences, and it might be especially important to be aware of any diagnostic uncertainty related to these symptoms.”

The review was led by Dr Mary Dahm (ANU ICH) together with student William Cattanach (ANU Medical School), Maureen Williams (health advocate and member of the ANU ICH Consumer Reference Group), Dr Kelly Gleason (Johns Hopkins University), Dr Jocelyne Basseal (University of Sydney) and A/Prof Carmel Crock (Royal Victorian Eye and Ear Hospital)

The article is available open access (free of charge) at the Journal for General Internal Medicine or by contacting the lead author Dr Dahm at


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