Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Is that so?


Patients and families may share experiences that we feel are inaccurate, improbable, or impossible. Discussing their statements nonjudgmentally helps to form trusting relationships.  

It’s not uncommon for patients to report information or identify concerns that we feel are questionable. However, telling them that we don’t believe them is a surefire way to impair our relationship. No one appreciates it when it’s implied that they’re lying, and children and adolescents, whose perspectives are typically valued less than adults’, are particularly sensitive to this experience. Parents who feel that their child’s clinician isn’t understanding or is intentionally disregarding their concerns are likely to have difficulty trusting that their child is safe. Our disbelief could even cause harm if it leads us to dismiss relevant information.

Here are strategies that can help to prevent this:


1. Gently identify discrepancies. 

Feelings of disbelief are often triggered by discrepancies between parent and child, current report and the patient’s history, and/or reported and expected symptoms. Nonjudgmentally noting these, while demonstrating that you’re curious about the other person’s thoughts about what you noted, can often quickly resolve them. 


2. Remember that you’re only seeing a snapshot. 

Children and parents in medical settings often experience high levels of physical discomfort or emotional distress which may impact their ability to communicate clearly. Missing context or information often contributes to our skepticism. Asking additional questions when we feel unsure about something a patient said can elicit information they may not have shared and provide needed clarity. 


3. Emphasize active listening and validation. 

This is at the core of developing rapport and effectively communicating with patients and their families. It requires listening attentively and nonjudgmentally, and then demonstrating that we’ve listened by paraphrasing or asking follow-up questions. Equally critical is validation: communicating that we understand the patient’s perspective and that their concerns are valid. This can both help us gather the information needed to assuage our doubts and develop strong relationships with patients. 


4. Be aware of our biases.

Our personal and training backgrounds, life experiences, and implicit biases all color the lenses we have of patients. It’s critical to be aware of any predispositions to disbelieve patients based on their characteristics or the nature of the information they’re sharing.  


5. Be mindful in written documentation. 

Patients can now read clinical notes, so it’s important to be thoughtful about word choice. When summarizing a patient’s responses, language which may imply disbelief (like, “Patient claims to have X symptom”) should be avoided, and neutral language (like, “Patient reported experiencing X symptom”) should be used.








This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.