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Communicating diagnostic uncertainties to patients: The problems of explaining unclear diagnosis and risk
Christchurch Hospital; Christchurch, New Zealand
| The first 150 words of the full text of this article appear below. |
EXPLAINING DIAGNOSTIC UNCERTAINTY
Mr Kastagir attended his local emergency department with chest pain. Local data on prevalence suggests that the pretest probability of a patient with suspected cardiac chest pain having an acute coronary syndrome is approximately 25%.1 His physician is also aware that after serious disease has been excluded, the precise cause of the symptoms can often remain unclear.
When a clinician sees a patient with an unclear presentation, 2 of the most important questions are (1) What is the exact diagnosis? ("What is the cause of my chest pain, doctor?"), and (2) What is the risk to the patient from the most potentially harmful differential diagnoses? ("Am I going to die from a heart attack?")
Both questions are important. However, clinicians and patients emphasise these questions differently. For example, patients may want to know the cause for their chest pain, while clinicians focus on the inclusion or exclusion of serious cardiac
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