The third guest—ambiguity

Imagine a consultation room. Two people, patient and doctor, discussing symptoms, test results, and possible diagnoses. The physician explains that there’s a wide spectrum of possibilities for the patient’s symptoms and test results. But the patient wants to know: “What exactly is the diagnosis?” 

At that very moment, a new player enters the room, pulls up a chair, and takes a seat. Although invisible, they’re uncomfortably present. The third guest: uncertainty. It fills the room with a mixture of fear and distrust. 

When things are not evident 

Often, we face the fact that there’s no definite diagnosis, or the disease is not evident. Lupus erythematosus, rheumatoid arthritis . . . You can’t exactly see the reason why the skin is red, or the lungs are swelling, only the consequences. 

In these situations, patients need clear explanations and guidance. Otherwise, patients may feel very confused; the trust in a patient-doctor relationship may disintegrate. Here are a few things I’ve found helpful:  

1. Use metaphors 

Try to draw a picture in the patient’s mind. Autoimmune diseases can be compared to a battle, with your defenses backfiring on your kidneys, for instance. Images are a powerful instrument to transform immaterial entities into a comprehensible mechanism. 

2. Explain what is not. 

If you rule out cancer, for example, let the patients know as soon as possible. People sometimes imagine the worst-case scenario, so be sure they understand what is not happening. 

3. Encourage questions.  

Some people are shy or don’t want to appear stupid. Explain that their questions are important to you, and that it’s part of your job to explain things as clearly as possible.  

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