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

When patients emphatically question the diagnosis


Sometimes patients and families struggle when processing a new diagnosis. Embracing open communication, education, and collaboration may transform disagreements into understanding. 

A young patient arrived at our clinic with a two-year history of widespread joint pain. Despite consultations with four different specialties, no one found a cause. After over an hour of chart reviews, psychosocial assessments, and a comprehensive medical examination by our multidisciplinary team, the long-awaited moment had arrived: a definitive diagnosis. While I expected this to be a moment of relief, that there was finally a name for the pain and a plan for treatment, the family expressed dismay, insisting there must be another explanation. They disagreed with the diagnosis and asked for additional testing about concerns that had already been assessed.  


This scenario may sound familiar. You’ve used your best knowledge and given your best care, but the patient and/or family disagrees with your conclusions. How can you help them move forward? Here’s three things I’ve learned:   


1. Promote open communication.
Welcome questions and concerns about diagnosis and treatment.   


2. Educate and inform.
Uncover any misconceptions about treatment or how conditions are diagnosed that patients or families may have. Give clear and detailed explanations about how you arrived at the diagnosis. Offer metaphors, examples, and visuals to help them understand your conceptualization or treatment.  


3. Collaborate with patients and their loved ones.
Address all concerns and practice shared decision-making. This collaborative approach can enhance trust and lead to more effective treatment plans.










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