A defence of causing patients to worry

Why it matters

Doctors are often motivated by a desire to avoid causing their patients worry. For example, fifty years ago it was common practice not to tell patients about a terminal cancer diagnosis.

In recent decades, the doctor-patient relationship has shifted towards giving patients more information. It’s not clear whether withholding upsetting information is the right thing to do – especially when a diagnosis, expected outcome, or treatment plan is uncertain, or when letting a patient know about uncertainty might be distressing.

In this paper, we defend the practice of disclosing diagnostic uncertainty to patients and argue that the practice of not acknowledging such uncertainty – or disclosing the possibility of a different, potentially serious diagnosis – to avoid worrying a patient, should be challenged.

What we found

Doctors need to think carefully about how they communicate uncertainty to patients.  Acknowledging that they are not sure, and discussing differential diagnoses, can improve mutual understanding, but this must be weighed against the risk of upsetting or worrying the patient.

A recent study showed that doctors don’t always tell patients when they’re unsure about a diagnosis, often because they want to avoid causing worry.

However, sometimes worry can be helpful. It can drive changes to a patient’s behaviours which are ultimately good for their wellbeing. On the other hand, excessive worry, or worrying about things which are outside the patient’s control, may be harmful.

Even when worry is harmful, communicating worrying information can still sometimes be justified – for example, if the benefits (such as helping people prepare or make better decisions) outweigh the harms.

There is growing empirical evidence to suggest that patients often prefer their doctors to be open and honest throughout the diagnostic process, even if hearing that there could be a serious but uncertain diagnosis worries them.

At the same time, we note that it can be difficult to predict how individual patients will respond to worrying information, as not everyone wants to know about diagnostic uncertainty.

Ultimately, we conclude that doctors shouldn’t focus only on avoiding patient worry. Patients often want honest information, even if it’s upsetting. Doctors should think carefully about the overall impact of what they say – including checking their own biases – and decide whether it’s better to share uncertain or difficult information, even if it worries the patient.