In Defence of Causing Patients to Worry: Ethical Issues in the Communication of Diagnostic Uncertainty.

Abstract

Doctors are often motivated by a desire to avoid causing their patients worry. In this paper, we provide a defence of disclosing diagnostic uncertainty information to patients, even if such disclosures are worrying. We first consider whether making a patient worry harms them, arguing that worry can be harmful in some-but not all-situations. Although worry is an aversive emotion, sometimes, worry can be beneficial (e.g., if the worry drives adaptive behaviours that are ultimately good for the patient's well-being). In contrast, worry that is excessive, or is related to events outside the patient's control, can be considered harmful. Even if worry is harmful, communicating worrying information can still sometimes be justified-for example, by applying a consequentialist harm-benefit analysis to consider whether the other benefits of the disclosure (broadly defined) might outweigh the harm created by the worry. We summarise the growing empirical evidence that suggests that patients often prefer their doctors to communicate transparently throughout the diagnostic process, even if the acknowledgement of serious but uncertain diagnoses induces some worry. We do, however, note the difficulty in predicting how an individual patient will respond to the disclosure of potentially worrying information (as the preference for greater communication of diagnostic uncertainty may not be universal). We conclude that a holistic consideration of the expected consequences of communication-including self-assessment by the doctor to avoid unwitting bias or unwarranted projection of their own values-often supports the communication of diagnostic uncertainty information, even if it worries the patient.