9 Communication of uncertainty, diagnosis and trust

Background Diagnosis is a complex and challenging clinical and communicative task. The rate of diagnostic errors, including missed, delayed, and misdiagnosis, has remained prevalent at 10–15% over the last few decades (Graber, 2013). Diagnostic errors can be a major cause of loss of trust in the doctor-patient relationship. Clinicians use ‘diagnostic statements’ to name, describe or explain the health problem to patients. If uncertain, clinicians are encouraged to share their working diagnosis and give an indication to their level of uncertainty. Communicating uncertainty can impact the success of relational trust in medical interactions. But, research on the communication of diagnostic uncertainty is sparse. Objective To explore links between communication of uncertainty in diagnostic statements and trust in doctor-patient interactions. Methods Combining interdisciplinary insights from medicine and applied linguistics, we analysed a corpus of 16 transcribed, video-recorded role-plays recorded during a practice high-stakes exam for international medical graduates (n=16) to gain medical accreditation in Australia. Fifty percent of doctors communicated the correct diagnosis. Analysis of the entire interaction traced discourse features associated with building relational trust. Informed by literature, we identified all diagnostic statements and analysed deductively for type of statement, ranging from plain assertions, to providing evidence to generalisations, and to identify implicit and explicit discourse feature associated with expressing uncertainty. Results Preliminary results showed that in role-play interactions with incorrect diagnosis clinicians drew more heavily on evidence in their diagnostic statements than in interactions with correct diagnoses. This suggests that clinicians might seek to build trust by supporting uncertain diagnosis with evidence. Conclusion There is a complex interplay between a clinician’s accuracy of diagnosis, their use of implicit vs. explicit expressions of uncertainty (e.g. modal verbs vs. ‘I don’t know’) and the creation of trust. We are currently exploring this complex relationship to understand how trust can be enhanced.