Unclear diagnoses used to shake my confidence and it would for anyone. Back then, I did not consider it as a part of learning, instead took it a little too personally.
But then that is what residency and the rigorous training teaches. Uncertainities are believed to mirror incompetence, something we all believed in our learning phases. Real clinical practice teaches you that not every case is the same, the plan/ symptoms mentioned in textbooks are not very clearly indicative in clinical practices and with only the right experience we can comprehend the right path to get to it.
A good clinician is not someone who always knows the answer, they however, do know the right way to get to it.
As an oral and maxillofacial surgeon, I have seen how maxillofacial pathologies and their diagnosis can be so tricky and mind wrecking, especially when we have a limited amount resources in terms of investigations or the general health of the patient is not supportive of invasive procedures.
And when a diagnosis isn’t obvious, the answer isn’t panic, it’s about knowing the right thing to do.
What do I personally do, when I feel stuck at some point is:
- Go back to the basics. Re-examine the patient and be certain of my findings, because I need to be sure of whatever is my control.
- Document findings and thought process clearly.
- Revisit imaging and at the same time also consider their availibility. Also, imaging and lab investigations should not entirely replace our judgement instead should serve as an adjunct.
- Keep a broad but logical differential diagnosis based on the clinical findings and investigations.
- Correlate our investigational findings clinically.
- Discuss openly with seniors and colleagues.
- Most importantly, communicate honestly with patients. Uncertainty handled with clarity builds more trust than false confidence ever can.
- Prioritize close follow-up. Many lesions subside, many diagnoses declare themselves over time.
Most importantly, I learned to accept uncertainty without letting it define my competence.
Because unclear diagnoses don’t mean you’re not good enough.
They mean you’re in an actual clinical practice.
And growth begins the moment you stop fearing that uncertainty, accept where you are wrong and start learning from it.
How do you handle unclear diagnosis ?
MBH/PS