Uncertainty in the Diagnosis: How Do You Want That Told to You?
The patient comes to me
Sick with symptoms and uncertainty
Is it bad; is it fatal, can I be cured?
She sits in front of me with that look
That look asks me to tell her the answers
“Sure” I think to myself
No uncertainty on my part to myself
And I guess no uncertainty is on my face
I say to her “Tell me how you feel”
Then comes the stream of symptoms and complaints
I try to keep the stream from flooding my understanding
In my mind the diagnoses start their own stream
It could be this, it could be that, but it couldn’t be the other
Or could it?
I reassure myself. The physical exam will sort it all out
But does it? I thought it would but it doesn’t
Maybe this or that seems now unlikely but yet on the other hand…
The history and physical is over and the patient sits in front of me
She awaits my diagnosis
But, in fact, I, myself await the diagnosis
Is uncertainty now seen on my face?
I have no decision since, in fact, I am undecided.
How do I respond to her and her look for me to tell her the answers? I would like your help. Should the words “I don’t know yet” come from my mouth? Will that be therapeutic for her symptoms and her concerns? Should I say “Well, it could be this, it could be that, it could be…It could be”?
Should I say “I know it could be this, I know it could be that, I know it could be… it could be”? Should I just say “I am just uncertain as to what is wrong with you so let’s wait until the tests are back”? What is wrong for the doctor telling the patient “I just don’t know at present”? Or is it wrong for the doctor to be expressing uncertainty to a patient who has symptoms and herself uncertainty? Help me understand how you would expect the doctor to express the doctor’s uncertainty about your symptoms and concerns. ..Maurice.