Communicating uncertainty. William Osler once said that “medicine is a science of uncertainty and an art of probability.” Clinicians have the opportunity to clarify unnecessary uncertainty—also known as the knowable unknown—with patients, but also state what is unknown. Although this may cause anxiety among clinicians, and many feel sharing uncertainty with patients can overwhelm and confuse those patients, conveying direct expressions of uncertainty, such as “I don’t know” or “It’s unclear,” can result in higher levels of positive talk, patient engagement and satisfaction.10
Much is still to be learned about expressing uncertainty to patients, but a 2016 National Academy of Medicine Report, Improving Diagnosis in Health Care, recommends that clinicians share their working diagnosis with patients, including the degree of uncertainty associated with each diagnosis.11
Dispelling misinformation. On the flip side of communicating uncertainty is the need to communicate the truth and dispel medical misinformation, which has been identified by the Surgeon General as a major public health threat. Obviously, this is also the ethical, morally correct and legal thing to do—and, from a clinician’s standpoint, the costs of disseminating misinformation even risks disciplinary action by state boards, according to the Federation of State Medical Boards.
Pivoting in our role as the clinician. As patients consume more external information and present that to their healthcare team members, the relationship of the clinician to the patient changes. The knowledge balance between clinician and patient shifts to a more equal footing, and patients are more empowered to direct their own care.
As clinicians we need to acknowledge that patients will continue to seek medical advice through the internet—no matter what—and will find both accurate and inaccurate information. We need to be prepared to serve more as consultants or advisors in certain circumstances.8 We can anticipate what patients may do online and help guide them to websites and internet resources with legitimate information, knowing we will continue to provide access and expertise on higher order diagnostic and therapeutic procedures.
An overarching challenge here will be how to align consumer-driven care with value-based care.
Messaging. Clinicians communicate with patients behind closed doors, via electronic record messaging systems, through phone calls and by letters to other healthcare team members. These offer extremely valuable opportunities to work with individuals and address information or misinformation with the tools we are empowered and trained to use.
Also try taking a step out of your comfort zone to communicate with patients. Join a social media platform on Twitter or Facebook, write an article for the local newspaper or magazine, or volunteer to speak at a community organization or event. These are additional ways to convey critical health information to the community.
