Some evidence suggests that clinicians' discomfort with diagnostic uncertainty can lead to communication by clinicians that can be perceived by patients as dismissive of their symptoms. The latter has been documented extensively in prior work. A remedy may be a leveling of clinicians with patients via the transparent communication of their diagnostic uncertainty in the medical interaction. Thus, this paper sought to explore 1) patients' attitude toward clinicians' transparent communication of diagnostic uncertainty, and 2) whether clinicians' transparent communication of diagnostic uncertainty would influence their trust in them. Data were collected via semi-structured interviews with 20 U.S. patients with endometriosis as part of a larger interview study. All 20 participants reported that, upon reflecting on their diagnostic journey, they would have preferred having clinicians communicate their diagnostic uncertainty to them. They commented that such communication would have contributed positively toward their trust in them, particularly because of clinicians’honesty. Participants detailed that they understand and do not expect clinicians to know everything or to be infallible. They also reported that such communication would have allowed for more informed patient decision-making regarding their care, such as whether to seek a second opinion. However, participants noted that communication of diagnostic uncertainty alone would not have been supportive ; rather, such communication must be accompanied by further clinical action or responsiveness on the part of the clinician.
Commentaire du Dr Marius Laurent (PAQS)
- Vingt patientes qui ont fait partie d’une étude sur l’endométriose sont interviewées. Toutes ont eu un parcours diagnostic long et compliqué. Toutes sont d’accord pour dire que la communication par le médecin de ses doutes et de son incertitude les a aidées, mais surtout parce que ces doutes induisaient des actions positives (nouveaux examens, nouvelles hypothèses…). Cet aspect est une condition essentielle au maintien de la confiance. Cette communication renforce l’impression d’honnêteté de la relation, et ouvre la porte à des décisions informées des patientes (essentiellement demander un deuxième avis). Notons que la perception de la compétence du médecin n’a pas été explorée spécifiquement : des commentaires ont simplement noté qu’on ne peut pas s’attendre à l’omniscience du médecin. Notons que l’endométriose est un diagnostic rarement évoqué d’emblée, il est souvent établi tardivement dans le trajet diagnostique, après exclusion d’autres pathologies. La communication d’une incertitude dans un trajet diagnostique court n’aurait peut-être pas été ressentie aussi positivement.
Bontempo AC.Patient attitudes toward clinicians’communication of diagnostic uncertainty and its impact on patient trust. SSM - Qualitative Research in Health 2023;3. Doi : 10.1016/j. ssmqr.2022.100214.