How to Tell a Patient "I Don't Know"

How do you react when you don't know the answer to a patient's question? Does your face flush? Do you reply with an answer that doesn't directly address the question asked? Do you abruptly end the conversation? Experts say that the words "I don't know" might be some of the hardest to say, even more so than "I love you". Admitting uncertainty or lack of knowledge isn't easy - just ask children and Alzheimer's patients who confabulate rather an utter a simple "I'm not sure". As nurse practitioners, however, we inevitably find ourselves in situations where we don't have the answers. 

The way we react as healthcare providers when we lack knowledge, or are uncertain about a patient's diagnosis, treatment, or disease state is important. Our response dictates the tone of the patient-provider relationship. Ironically, admitting you aren't sure about something can inspire confident on part of the patient. Skirting the question, or worse, giving potentially false information, damages your credibility, and may even place the patient in harm's way. So, how do you indicate uncertainty as a nurse practitioner without compromising your position as an expert?

1. Identify the Reason

There are two reasons you may have to utter the words "I don't know" in your practice as a nurse practitioner: 

  1. Lack of knowledge - the information exists, and you don't have it
  2. Uncertainty - after exhaustive diagnostic testing and expert consultation, and answer could not be found, or a diagnosis could not be made

​Both types of interactions with patients can be uncomfortable, but may require a different approach. If you are a new graduate, or less experienced nurse practitioner, you will be faced with the uncomfortable state of dealing with your lack of knowledge related to your level of experience on a daily basis. 

2. Don't Panic

If a patient asks you a question to which you don't know the answer, or, if you can't definitively diagnose or treat a patient's medical condition, don't panic. Take a deep breath, and continue to speak with confidence. Consider the possibility that admitting you don't know can actually be an asset to provider-patient relationships. Even if you don't know the answer, you are still on the patient's team in figuring it out, and they find comfort and reassurance in having someone interested in their best possible outcome on their side. 

3. Decide if there is actually an answer 

Not every medical condition can be specifically diagnosed and effectively treated. Sometimes, as nurse practitioners, there really is not an answer. Perhaps your patient has exhausted available healthcare resources, and has not arrived at a conclusive diagnosis or acceptable treatment. Or, in your practice setting you are not able to make a definitive diagnosis and must refer the patient out. 

In either of these cases, offer reassurance. Let the patient know what you do know. For example, you might say, "The good news is that we know you don't have...". Offer a partial solution to the patient's problem even if you don't have all the answers they are seeking. Find ways to alleviate the patient's symptoms, so they can cope with the condition as effectively as possible. 

4. Avoid blame

When patients present with a set of symptoms that don't fit, or lead to a definitive diagnosis, the temptation of some providers is to believe the condition is all in the patient's head. And, it might be. Avoid the temptation, however, to dismiss or downplay the patient's concerns. To them, the problem is very real. 

5. Find the answer

When you aren't sure of something related to a lack of medical knowledge, there is a better way to let the patient know than an "I don't know". Responding with "I'll find out" is a highly effective answer. Let the patient know you would like to consult a colleague, a research article, or medical resource, to find the information or verify your thinking. Your patient will appreciate the time, effort, and honesty. The patient may even feel a greater degree of reassurance given that they are getting collaborative advice. Not to mention, if you don't seek out the answers yourself, you won't learn. 

Helpful tip: When you do need to consult another professional or resource, take a moment to ask the patient clarifying questions. The more information you have, the easier it will be to find an answer. 

6. Give it time 

Conveying confidence behind your "I don't know" delivery takes time, especially if you are inexperienced and feel like you should know an answer. Practice the way you interact with patients in these potentially awkward situations by role playing the conversation with colleagues. And, remember, patients will find reassurance in the way you handle situations, not just your answers. A missing answer doesn't mean failure. 

7. Reassuring actions

There are a few practical steps you can take to improving your approach to "I don't know" interactions. First, write the question down. This makes people feel heard. And, it assures you won't forget the question or to work on finding an answer later. Second, it's OK to share the information you do have. Saying something along the lines of "based on what I do know, my thoughts are...". This way, the patient leaves with at least partial information, and you can get back to them later with a more complete response. Finally, give the patient a timeline for getting back to them with the requested information. Will you seek an immediate answer, or discuss at their next appointment? Or, can they expect a call next week?

Uncertainty in medicine, and inexperience in practice aren't always easy to deal with. But, with practice, they are challenges that can be overcome. 

 

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Comments

I like "That's a great question." and followed by "Well, here's what we do know so far..."

Melissa

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