SCA Exam Tips: Dealing with Medical Uncertainty in a GP Consultation
Effectively communicating medical diagnostic uncertainty is not singularly standardized. Factors influencing this discussion include the clinician’s experience, confidence, and approach to sensitive communications.
Avoid Jargon: Use clear and straightforward language.
Avoid Hesitancy: Do not sound hesitant or fearful, as patients may interpret this negatively, thinking the diagnosis is poor or that information is being withheld.
Acknowledge the Uncertainty: Example: “David, based on the information we have gathered so far, the diagnosis is not clear at the moment. There are a few possible diagnoses that we need to consider.”
Explain the Next Steps: Example: “In these situations, we typically conduct a sputum sample and blood tests to help us reach a diagnosis or at least narrow down the possible causes of your symptoms.”
Accept and Reflect the Patient’s Emotions: “I can see, David, that you are quite anxious about this uncertainty, which is completely natural. It is something we encounter often as doctors.it is part our job is to deal with uncertainty, keep you informed and safe while we try to reach a diagnosis. Is that okay?”
Incorporate ICE (Ideas, Concerns, Expectations), Shared-Care Approach, and Clinical Guidance to Reach a Provisional Diagnosis or Management Plan: “David, although you are quite well at the moment, considering your upcoming trip and past experiences of requiring hospital admissions abroad, we can consider prescribing a delayed antibiotic prescription for you to use if you develop the following symptoms…”
Follow-up Plan and Safety Net to Mitigate Risk: Example: “David, once your three early morning sputum sample results and chest X-ray are back, we can have a follow-up appointment to discuss the results and next steps. In the meantime, please attend A&E if you cannot talk in full sentences or are experiencing worsening shortness of breath or chest pain. If you start the antibiotics and your symptoms worsen after 48 hours, seek a medical review with the GP. If it’s an emergency, please call 999 or go to A&E as discussed.”
