Into the Unknown: Helping Learners Become More Comfortable With Diagnostic Uncertainty.

Abstract

> A diagnosis is a judgement characterized by uncertainty and probabilistic reasoning: it is seldom definitive at the initial point of care. > > Gurpreet Dhaliwal, MD Great clinical teachers recognize that uncertainty is an inherent aspect of making a clinical diagnosis, particularly when symptoms are nonspecific or change over time. In a recent review, diagnostic uncertainty was defined as a “subjective perception of an inability to provide an accurate explanation of the patient’s health problem.”1 Physician discomfort with uncertainty has been associated with burnout, over-testing, increased health care expenditures, and diagnostic errors.2,3 Over time, skilled clinicians become increasingly comfortable with accepting and navigating uncertainty, in part because they treat diagnoses as provisional hypotheses or “working diagnoses” instead of definitive diagnoses.4,5 They recognize that clinical reasoning in the face of uncertainty requires a thought process in which several potential diagnoses are weighed as new information is considered, evaluated, and contextualized.6 Learners commonly struggle when … Address correspondence to Jimmy B. Beck, MD, MEd, Seattle Children’s Hospital, 4800 Sandpoint Way NE, Mailstop FA.2.115, PO Box 5371, Seattle, WA 98105. E-mail: jimmy.beck{at}seattlechildrens.org