Takeaway
When facing diagnostic uncertainty, clinicians can practice "paying heed"—a careful attentiveness that helps patients feel truly heard, especially when their symptoms are hard to articulate.
Connecting with patients | August 17, 2026 | 2 min read
By Gail Berkenblit, MD, PhD, Johns Hopkins Medicine
“Whenever I sit with a patient, I try to see the world through their eyes.”
—Dr. Ed Kraus, Johns Hopkins Medicine
A patient’s difficulty with describing neuropathy
When a patient came to me with concerns for neuropathy, he noted how hard it was to find the words to describe his symptoms. While some patients present with textbook burning or tingling, lancinating pain or numbness, there are many other ways people have described the sensation to me. Some patients will have hyperalgesia or allodynia, experiencing pain taking a shower or wearing socks. Others will just perceive vague deep pain that they may ascribe to muscle aches or poor circulation. This particular patient described his pain as a feeling of “walking on bubble wrap”.
Barriers to being heard
But there are other reasons that neuropathy can be difficult for a patient to voice. The gradual onset, random fluctuations, lack of experience, and commonly co-occurring brain fog all combine to create apprehension, self-doubt, and a fear of medical gaslighting. My patient shared, “I was doubting my own veracity.” And so, how could he expect his physician to trust him?
Paying heed
In such a situation, active listening can allay many of these fears. Dr. Mary Catherine Beach’s conceptualization of active listening starts with curiosity and interest, driving a cycle of attention, understanding, and serious consideration. (Click here to watch her presentation on this topic.) When faced with diagnostic uncertainty, my approach adjusts this model by substituting serious consideration with “paying heed.” The word “heed” comes from Greek, “to see; to look into; to beware and to behold.” It means to pay close attention to something or to be careful about it, often used in regard to advice, warnings, or potential danger. It’s the wary alertness of the deer rather than the deliberate consideration of the leopard.
Practicing heed
As I reflected on this word, I wondered whether practicing heed was, in fact, in conflict with the ideal of being aequanimitas. As Osler defined it, aequanimitas is “coolness and presence of mind under all circumstances, calmness amidst storm, clearness of judgment in moments of peril.” Rather than choosing between them, I’ve found it helpful during instances of diagnostic uncertainty to combine heed with aequinimitas. If we become too fearful, it may cloud our judgment, lead us to order too many tests, even make medicine uncomfortable to practice. But in the right amount, taking heed can help us pay attention, sharpen our focus, and assure our patients that they are heard. To pay heed is to commit, with utmost care, to seeing the world through their eyes.
In this patient encounter, careful attention to the patient’s vague and easily overlooked symptoms revealed a patchy loss of light touch and temperature sensation over his legs. It prompted his neurologist to look beyond the initially negative lab workup and normal EMG, and a subsequent biopsy ultimately confirmed the diagnosis of small fiber neuropathy. The diagnosis brought clarity to an experience that had left him doubting himself, and it offered the relief of finally feeling heard.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.