http://bmj.com/cgi/content/full/324/7336/543

BMJ 2002;324:543 ( 2 March )

Letters

Effect of patient centredness and positive approach

    Airing uncertainty can be positive
    Partnership of patient and doctor may provide key to patient satisfaction

Airing uncertainty can be positive

EDITORLittle et al say that doctors should be aware that airing their uncertainties might reduce satisfaction and empowerment.¹ This conclusion is not really supported by their research because the positive approach statements dealt with the patient's problem and not the specific diagnosis. It is possible for the doctor to acknowledge uncertainty about a diagnosis or prognosis while giving the patient a clear positive message about what they can expect to happen, or what the doctor thinks they could do about the problem and what to do if things do not go according to expectation.

This safety net is likely to be perceived as positive by the patient, who may feel even more empowered as the doctor has clearly planned for the uncertainty that all patients know exists. Pretending to know the future or exact diagnosis fools no one and is likely to lessen satisfaction and empowerment. Helping patients to handle uncertainty effectively is an important part of enablement. This clarification of what is meant by a positive approach should be addressed in future research.

David Shepherd, general practice principal. 
Saffron Group Practice, Leicester LE2 6UL daveshep@fish.co.uk

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