Communicating diagnostic uncertainties to patients: The problems of explaining unclear diagnosis and risk

Than, Martin P. and Flaws, Dylan F. (2009) Communicating diagnostic uncertainties to patients: The problems of explaining unclear diagnosis and risk. EBM Online, 14 3: 66-67.


Author Than, Martin P.
Flaws, Dylan F.
Title Communicating diagnostic uncertainties to patients: The problems of explaining unclear diagnosis and risk
Journal name EBM Online
Publication date 2009-06
Sub-type Article
DOI 10.1136/ebm.14.3.66
Volume number 14
Issue number 3
ISSN 1473-6810; 1356-5524
Start page 66
End page 67
Total pages 2
Place of publication London, U.K.
Publisher BMJ Group
Language eng
Formatted abstract Mr Kastagir attended his local emergency department with chest pain. Local data on prevalence suggests that the pretest probability of a patient with suspected cardiac chest pain having an acute coronary syndrome is approximately 25%. His physician is also aware that after serious disease has been excluded, the precise cause of the symptoms can often remain unclear.

When a clinician sees a patient with an unclear presentation, 2 of the most important questions are (1) What is the exact diagnosis? (‘‘What is the cause of my chest pain, doctor?’’), and (2) What is the risk to the patient from the most potentially harmful differential diagnoses? (‘‘Am I going to die from a heart attack?’’)

Both questions are important. However, clinicians and patients emphasise these questions differently. For example, patients may want to know the cause for their chest pain, while clinicians focus on the inclusion or exclusion of serious cardiac disease. If the clinician feels serious disease has been ruled out and tells the patient, the latter may still feel dissatisfied and worried because the cause of the pain has not been discovered.

How do we handle these non-specific diagnoses? We have found it helpful to warn patients that we may not arrive at a definite diagnosis before investigation...
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Published under "EBM notebook".

Document type: Journal Article
Sub-type: Article
Collection: School of Nursing and Midwifery Publications
 
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Created: Thu, 24 Mar 2011, 20:46:35 EST by Mr Dylan Flaws on behalf of School of Nursing and Midwifery