Uncertainty is genuinely tough to talk about. Add to that there’s different types of uncertainty, there’s pressures of different kinds around communicating about uncertainty, and the stakes are high for the patient’s health outcomes and for the therapeutic relationship. Fun times. So today’s episode, I’ll share some thoughts and three specific, concrete moves you can add to your repertoire when you’re talking about uncertainty.
Hi, everybody. This is 10 Minutes to Better Patient Communication from Health Communication Partners. Since 2017, we’ve been giving you inspiration and strategies to improve engagement, experience, and satisfaction. I’m Dr. Anne Marie Liebel, a researcher, consultant, and educator specializing in communication and education. This podcast makes space to dig into what it’s easy to take for granted about communication in our professional lives, especially in healthcare and public health, but increasingly across sectors because communication touches everything. We’re here to learn and get inspired, but most importantly, make the difference we got into our jobs to make. I help organizations act with clarity and confidence in complex, high-stakes situations. I’m currently booking consulting clients. You can work with me. Reach me on LinkedIn, on Instagram at Health Communication Partners, or at healthcommunicationpartners.com.
Now, this episode, like many episodes, came out of an actual conversation I was having with a client who said, “How do we present information that’s clear, that’s not confusing, that inspires trust, that allays fear?” And that’s a lot of weight. That’s a heavy load to put on communication. And add on to that, the fact that we were talking about communicating about uncertainty in particular.
Now, this is a topic that multiple people have brought up with me. So first, I want to set the scene with a few things we know, right? You regularly have to communicate about different types of uncertainty. Now, I love me a taxonomy. And one I found grouped uncertainty into three broad domains. You may have seen this one. The first is aleatory uncertainty. This is the chance-related kind, like there’s some randomness inherent to the situation, and that’s why it’s uncertain. Another is epistemic uncertainty. This is gaps in knowledge. There’s just things we don’t yet fully understand, and that’s why there’s uncertainty. And then there’s ambiguity. Every day, conflicting or unclear information. Now I saw this taxonomy crop up a few different places, but I couldn’t find like the origin of it. So if you know it, please let me know because I love to geek out on stuff like that.
But each of these shows up differently in clinical conversations. And again, each of those is genuinely hard to talk about. Part of why this is hard to talk about is there’s social pressures. Because in everyday life, certainty is a prized characteristic. We tend to trust people who come at us with confidence. And AI has shown us how easy it is to fall into that trap of how like a confident tone can lead us to believe something maybe more than we should, even when it’s wrong. So when certainty gets linked to trustworthiness, expressing uncertainty can feel risky, like it might make you look bad.
There’s also pressure from another direction. And that’s this idea that there is a single right way to talk about uncertainty with a specific patient population, some formula, an optimal approach. And I want to at least invite you to step back from that assumption for a moment. Notice maybe what pressure you’re feeling when it comes to communicating about uncertainty. Maybe what does the system that you’re in assume about how patients respond to uncertainty? And hold that up against what you’ve noticed dealing with specific people in front of you talking about uncertainty. Because sometimes those two things don’t match.
But the whole reason for focusing on communication about uncertainty is an important one. It’s a crucial one. The key issue here is that when uncertainty isn’t communicated well, or when it’s mismatched to the patient, people may understand what’s going on. And then decisions or actions that flow from that conversational moment may not be what was intended. And that can lead to serious problems.
Here’s where it’s helpful to zoom out. Uncertainty is not unique to medicine right? We make decisions without full information all the time about our careers, our families, our finances. We have plans that might change. There’s outcomes we can’t predict. So it might be helpful to remember: patients are not starting from scratch when they walk into a clinical conversation that has uncertainty. Every patient comes into the room with a long history of dealing with uncertainty. The challenge is that those histories are different for each person. And they don’t always show up in obvious ways. Which is why a one-size-fits-all approach to uncertainty so often doesn’t feel quite right.
That brings me to the three things I want to offer and then the three moves that follow from them. Here we go.
One thought: Different people have different levels of comfort with uncertainty. You know this already at some level. Think of your own family. Who are like the data-driven people? Who’s comfortable with being like open-ended, fly by the seat of the pants? Now your patients are going to differ in how much they want to engage with uncertainty, how comfortable they’ll be hearing it, sitting with it, somewhat your probabilities, your ranges, somewhat we’ll watch and see. Others might experience that same level of ambiguity as distressing or even intolerable.
This matters practically because if you don’t know how much tolerance for uncertainty your patient has, they might default to avoiding something that’s reasonable because ambiguity feels risky. Or going with something overly aggressive to try to eliminate uncertainty. Or they might just disengage entirely because they feel overwhelmed.
There’s good evidence that shared decision-making improves decision quality and alignment with what patients actually value. And, you know, shared decision-making depends on honest uncertainty discussion. So this calibration to where people are in their comfort with ambiguity, uncertainty, isn’t some nice to have. It can affect outcomes.
So the first move: Find out where this person is in their comfort with uncertainty. You don’t have to guess. You can just ask. You can even offer two options. One that involves spending time with the uncertainty, going through the possibilities, looking at the data, and the other that’s a quicker summary and moving toward recommendations. Keep it simple. A small question gives you a way to calibrate in real time based on the person in front of you.
Okay. Two, a person’s comfort with uncertainty can shift. The same person who’s comfortable with ambiguity at work may be completely undone if you present them with some unplanned vacation idea. The same patient might handle uncertainty very differently depending on what’s at stake or where they are in processing what they’ve just learned. You can also change as a conversation unfolds, as decisions become more real.
So rather than assume consistency, like “the way they handled it last time is how they’ll handle it this time,” You want to go ahead and reassess, keep adjusting. So yes, the second move is that: keep adjusting. Instead of asking yourself, is this a detailed person or not? Try asking, where’s this person’s tolerance right now for this decision?
Now you are an expert observer and notice-r. So pay attention to your cues, how this person’s asking questions, whether they’re circling back to the same point. Whether they want to stay big picture or move quickly toward those recommendations. Let what you’re noticing guide how much detail, uncertainty, or direction you are offering.
And three, a gentle reminder: there’s nothing inherently good about certainty and there’s nothing inherently bad about uncertainty.
What’s true is that uncertainty is genuinely difficult to communicate and there are real pressures bearing down on that difficulty. You are trained to be clear. Patients look to you for guidance. And the various systems we’re a part of tend to reward confidence and consistency. And there’s something I want to just kind of name here, this well-described pattern where expressing uncertainty gets read as hedging or ignorance or failure. And so we as people want to avoid that. What happens in the clinical context, and there’s lots of research on this, uncertainty gets under-disclosed, confidence gets over -signaled, the opening for a real shared decision-making conversation narrows before it even starts.
None of this is about bad intentions. It’s about what culture tends to reward.
So the third move I’m going to suggest is replace that pressure that I’ve been talking about toward like one right way with a reliable way to find the right approach. You know the research. You’re keeping on top of it. You’re going to hold that in one hand, and then the other hand, you’re going to hold, well, what you’ve noticed about the person in front of you.
Even though patients differ enormously, your approach doesn’t have to.
Ask where they are. Adjust as you go. Pay attention to the results. Let your insights accumulate. Notice when the evidence fits. and when it doesn’t quite fit the person in front of you. This has been 10 Minutes to Better Patient Communication from Health Communication Partners. Audio engineering and music from Joe Liebel. Additional music from Alexis Rounds. Thanks for listening to 10 Minutes to Better Patient Communication from Health Communication Partners, LLC. Find us at healthcommunicationpartners.com.