Intended for healthcare professionals

Rapid response to:

Primary Care

Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations

BMJ 2001; 323 doi: (Published 20 October 2001) Cite this as: BMJ 2001;323:908

Rapid Response:

Airing uncertainty can be positive


Little et al state that ' doctors should be aware that airing their
uncertainties... might reduce satisfaction & empowerment". 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 perfectly possible to acknowledge uncertainty about a
diagnosis or prognosis whilst 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-netting' 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. I would suggest that helping our 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.

Competing interests: No competing interests

22 October 2001
David Shepherd
GP Principal & GP Trainer
Saffron Group Practice