Your Guess is as Good as Mine: Managing a Patient without a Diagnosis

Q: I’m an Internist, and I’ve been practicing for more than 16 years. A recent case prompted me to take a closer look at how we manage patients when we don’t yet know their diagnosis. Any guiding principles on this one

A: If there is one thing we physicians don’t like (and patients!) it's getting the diagnosis wrong. And it happens to the best of us. The Institute for Medicine's new report gives us a better sense of the totality of the challenge.

Here’s what we do know. The first step to reducing misdiagnosis is making sure clinicians are comfortable with and skilled in situations where we don't yet know the diagnosis. Knowing how to communicate effectively with the patient can instill confidence in the midst of uncertainty.

Here are some simple tips:

First: Say, “Here is what we do know.” Provide the patient a composite of symptoms and results framed around what is known.

Second: Provide a list of possibilities, essentially your differential diagnosis in order of probability.

Third: Stress the clinical team and patient partnership. “As a team we will work through these possibilities to get this figured out.”

These simple steps will give the patient assurance in circumstances when we don’t know the diagnosis. Let us know how this works for you and what you're doing to prevent misdiagnosis in your organization.