Takeaway
When the diagnosis is elusive or the best treatment is unclear, good communication makes all the difference. Convey your uncertainty with empathy, honesty, and transparency.
Connecting with Patients | December 9, 2025 | 1 min read
By Jeffrey Millstein, MD, Penn Medicine
Uncertainty is a fact of life in medicine—this is no secret. However, the way clinicians message this to patients can make all the difference between building or eroding trust. And this matters even with the least complicated complaints.
Recently, one of my middle aged adult patients came to the office to follow up after an urgent care visit for mild abdominal discomfort. The doctor told him he didn’t know what was wrong, but it was nothing to worry about. The patient heard this as, I don’t know what is wrong with you, and it doesn’t matter. He felt dismissed. The lesson—even in simple cases, expressing uncertainty should be accompanied by concerned inquiry about the patient’s true worries, and a clear follow up plan.
Expressing uncertainty can be even more challenging when there is a questionable prognosis, persistent symptoms with a diagnostic conundrum, or no definite best treatment plan. The words we choose—I don’t know, I’m not sure—are less important than how we say them. When a path forward is unclear, communicating with empathy, honesty, and transparency is especially critical. Patients don’t expect doctors to know everything, but they do expect us to accompany them on their illness journeys, work collaboratively to seek solutions, and honor their values and priorities along the way.
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This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.