Chapter 14
The pragmatics of diagnostic uncertainty
A closer look at hedges and shared understanding in diagnostic statements
Diagnosis is a complex communicative and clinical task. This interdisciplinary study explores diagnostic statements, specifically uncertainty, combining perspectives from medicine and linguistics. We infer divergent understanding of uncertainty expressions between patients and clinicians, linking them to diagnostic errors and shared decision making.
We analysed 16 role-play scenarios, applying discourse analysis to identify diagnostic statements and analyse them for shared understanding and expressions of uncertainty.
Results showed that in interactions linked to diagnostic error, clinicians heavily relied on evidence and expressed uncertainty indirectly through hesitations, false starts, and lengthy introductory phrases. This suggests clinicians use evidence and phrases as ‘shields’ to signal their lack of commitment to the diagnosis. If these shields aren’t recognised as such, shared understanding may be at risk.
Article outline
- 1.Introduction
- 2.Methods
- 2.1Data collection and participants
- 3.Analysis and analytical frameworks
- 4.Findings
- 4.1Diagnosis and diagnostic statements
- 4.2Trust: Approachability features
- 4.3Shared understanding
- 4.3.1(Un)explained medical terminology
- 4.3.2Self-repairs
- 4.4Hedges and expressions of uncertainty
- 4.4.1Explicit expressions of uncertainty
- 4.4.2Hedges: Implicit expressions of uncertainty
- 5.Discussion
- 5.1Explicit expression of uncertainty or certainty?
- 5.2Implicit expressions of uncertainty and explicated evidence as shields against diagnostic uncertainty
- 5.3Hedges as markers of relational work or diagnostic uncertainty?
- 6.Concluding remarks
-
References
-
Appendix
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Cited by (2)
Cited by two other publications
Dahm, Maria R, Laura J Chien, Jen Morris, Lucy Lutze, Sam Scanlan & Carmel Crock
2024.
Addressing diagnostic uncertainty and excellence in emergency care—from multicountry policy analysis to communication practice in Australian emergency departments: a multimethod study protocol.
BMJ Open 14:9
► pp. e085335 ff.

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