The three most useful words for a doctor

Here are the three most useful words for a doctor: “I don’t know.”

A close second would be “I’m not sure,” another three that have got me out of trouble more times than I can remember.  The older I get, and more experience I have, the more useful it becomes.

Pattern recognition is essential in effective medical practice.  So often patient complaints are vague and nondescript, and in the absence of physical signs, the most effective thing for a doctor to say is, “I don’t know, but it does not sound serious.”

When I tell someone with dizziness that I don’t know what the cause is, I’m already pretty sure about what it is not — hypertension, stress, migraine, Meniere’s Syndrome, acoustic neuroma, multiple sclerosis, etc. Some tests may be needed along the way — again it depends on the pattern and one’s own experience.

When there are worrying symptoms or physical signs, “I don’t know” needs to be followed by, “but here’s what we’re going to do to find out.”  Again pattern recognition and experience come to the fore.

All too often, especially among junior doctors, there is pressure to make an absolute diagnosis, and this involves test after test, doing no one any favors.  The truth is that accurate diagnoses for minor non-specific complaints will be impossible.  It is here where an honest “I don’t know, but it doesn’t sound serious” is valuable.  Some patients need to be told in addition that there is no evidence of serious disease.

Somewhere we doctors have been taught that a diagnosis is expected every time, and then followed by a drug prescription.  In many cases all people want to know is that we find nothing wrong and it does not sound serious.

An essential follow up is, “but if it does not get better, or becomes worse in any way, see me again.”

Coupled together, these two sentences go a long way in providing honest and open medical reassurance to patients.

Martin Young is an otolaryngologist and founder and CEO of ConsentCare.

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  • Trisha Torrey

    The ability to say “I don’t know” is crucial for a number of reasons:

    1. Your patients will trust you for being honest
    2. Your patients will realize that there just aren’t easily definable answers for every set of symptoms
    3. it gives you a chance to partner with your patients and invite their participation. Instead of dismissing them with “come back and see me” – why not suggest that you try to sort out answers together? Then maybe the patient will feel less dismissed, and more involved in the process. The patient may be the one to conclude that it was really nothing to be concerned with afterall.

    Thanks for raising this important point, Martin.

    Trisha Torrey
    Every Patient’s Advocate

  • Martin Young

    Good point, Trisha!

    I forgot to say that “I don’t know” to some extent offers a point of departure for the patient. Some people really, really want to pursue their symptoms, and may choose to change doctors at this point. But I agree, “Let’s work it out together” is a great open door statement.

  • Paul Dorio

    I agree with you and nice post, Martin. But I don’t think that “Somewhere we doctors have been taught that a diagnosis is expected every time, and then followed by a drug prescription.”

    What I think is at issue is complex but involves the public’s expectation that a diagnosis is always made once the doctor has been consulted. Example: a mother brings her sick child to the pediatrician. How many parents would be pleased to go home with just a diagnosis of “viral illness” and no antibiotics needed? Most people nowadays expect those antibiotics. One example of many. It’s a catch-22 of course. It does not explain or excuse the doctor who is incapable of admitting his/her fallibility. That, of course, is another of the issues at hand.

  • Outrider

    I sometimes add: “Does this sound like a reasonable plan?” (so we’re both clear that even though there is no definitive diagnosis, I actually have a diagnostic/treatment plan!!!)

  • Peter Westre RN

    My initial reaction on reading the title was exactly what you posted.

    If nothing else “I don’t know but it doesn’t sound serious” helps allay the anxiety of the “worried well” patient.

    Patients deserve honesty from both physicians and nurses. We need to listen to our patients in order to understand what their real concerns and fears are about.

    Thanks for a great article.

  • Ryan Madanick, MD

    I would echo this, double so for young physicians and medical students.

    They have often been taught that “I don’t know” is not a good answer, when in reality it is the best answer to have if they don’t know (e.g., when “pimped” on the wards/in the clinic).


  • Bryan Vartabedian

    As someone who treats kids with abdominal complaints, these 3 words typically lead off my dialog with parents. It’s the follow up to these words that are most critical. Understanding that you have a strategy to approach the issue is what counts.

    Nice post.

  • Robert F, ACNP-BC

    I agree wholeheartedly. This should not only apply to MDs, but any clinician (PA, NP, MD) who is given responsibility over someone’s health. Good post.

  • Marie Latta

    Thank you for this. Every doctor and patient should read and apply this.

  • Sara Stein MD

    I’m also a big fan of “I’m not sure”. Followed by “I’ll look it up, do you have a minute while I search?” Finally the famous nonverbal shrug with hands in the air says it all. Hopefully the take-home message is “we’re in this together, whatever it is.”

  • gzuckier

    “A doctor’s first duty is to ask forgiveness”
    -Ingmar Bergman

    • Paul Dorio

      I’ve been waiting for that one, gzuckier.

      Personally, although I’ve been mulling over the phrase that is discussed in the above post, I think that “I’m sorry” is probably the best phrase we doctors could use more frequently and in the right situations. I feel no issue with saying those three little words that mean so very much to so many people.

  • jon

    Why does Medicare pay twice as much in benefits per patient in McAllen TX vs. the national average? (also in numerous other areas of the country)

    Please read the following and respond to the Doctors (particularly the Cardiologist) comments to the reporter regarding malpractice suits. Nobody likes to admit it, but Doctors are human….they do not want to see their paychecks go down–so over-treating will continue unless and until “death panels” are instituted :)

  • Marie Latta

    I think it has been said in various ways, but I think it is critical that doctors don’t stop with “I don’t know”, but rather let that be the jumping off point for next steps or straegies.

  • Neil Baum

    Two Other Important Words-”I’m Sorry”
    The initials “M.D.” after your name indicated status, trust, and perfection. Most physicians realize that elevated status and abundance of knowledge, infallibility, and blind trust by our patients in their physicians are long gone and are the stuff of fairy tales. The media has highlighted the errors and mistakes and have hung out our dirty laundry for all to see. Then there is the Institute of Medicine’s study in 1999, which chronicled nearly 100,000 deaths as a result of medical errors. And certainly we can’t overlook the legal profession that is constantly at our heels threatening to litigate against us when the outcome is less than perfect.
    So what can we do? We can continue to assume a policy of deny and defend the situation when there is an undesirable outcome. Or perhaps we can adopt a policy that is more human and natural, i.e., an apology.
    An authentic apology is one that is heart-felt and driven by true regret or remorse. According to Dr. Woods, author of Healing Words-the Power of Apology in Medicine, there are five reasons to apologize:
    1. Shows the patient you respect them
    2. Shows you are taking responsibility for the situation
    3. Demonstrates you care about the way the patient feels
    4. Demonstrate your empathy
    5. Results in dissipating anger, and disarms the individual
    Perhaps when we are comfortable with the words “I’m sorry” and can say them easily and with sincerity, we can expect better healthcare, increased job satisfaction, and lower malpractice premiums

    • Paul Dorio

      Excellent! Much better than my shorter comment above where I suggested that “I’m sorry” might be more important than even “I don’t know.” “I’m sorry” is an acknowledgment to the patient that I care. “I don’t know” simply tells them that my fund of knowledge has a hole in it. So I’ll have to look something up.

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