When the Doctor Says “I Don’t Know”

This is one of the few studies that have looked at doctor-patient interactions in the Assisted Reproductive Technology (ART) field.

Study Background

Why: with the many knowledge gaps in the relatively new medical field of ART, this study sought to examine how physicians communicate uncertainty to patients

Where/When: eight public and private fertility clinics in Italy, 2013-2015

Who/How/What:

• 85 videos of medical interactions between an infertile couple and a reproductive physician were collected.

• One researcher scrutinized 20 of these 85 videos; it is unclear if these 20 videos were randomly selected.

• Another researcher randomly reviewed 4 of 20 of the twenty watched videos to determine if there was agreement in how the videos were analyzed. Disagreements were resolved by discussion.

• Five researchers discussed variations of “I Don’t Know” for inclusion/exclusion

  • inclusion = “don’t know”

  • exclusion = “we cannot know,” “how can I know,” and “It is impossible to know this in advance”

• Videos were microanalyzed for face-to-face dialogue when a physician stated “I don’t know.”

• Dialogues were translated literally word-for-word from Italian to English.

Results

• Median # of “I Don’t Knows” per appointment = 2.5 times

  • Male physicians (n = 3) said “I don’t know” 0-3 times

  • Female physicians (n= 7) said “I don’t know” 2-15 times

  • Little difference based on # of years in practice (<15 vs. >15 years experience)

• Total # of “I Don’t Knows” in 20 videos = 82

  • 73/82 propositional (“conveying negative epistemic stance”)

    • 49/73 for outright lack of knowledge

    • 17/73 uncertainty about terminology or ongoing behaviors

    • 7/73 to obtain information from patient

• 75% of patients heard their doctor say “I don’t know” and did not remark or question further

  • Patients were most likely to remark or question the doctor when it related to a doctor saying “I don’t know” relating to medical or scientific knowledge their doctor further when the doctor said “I don’t know”

• More results found within freely-accessible manuscript

Key Takeaways

Study Authors’ Conclusions

• ART doctors seem prone to transparency when it comes to a lack of knowledge - other medical fields could learn from the ART doctors who disclose uncertainty

• ART doctors might benefit from specific training on how to disclose unknowns

• Future studies should also examine non-verbal communication

This Pharmacist’s Conclusions

• Vanguard study

  • Worthy topic to explore and better understand

    • May improve physician communication

    • May improve patient satisfaction - patients seek honesty (vs. denial) from physicians

  • Serves as baseline for future exploratory studies

• Limitations

  • Unclear if the 20/85 videos selected for viewing were randomly chosen (if not, increased risk of bias towards a certain result)

  • Study results might not be translatable to cultures where conversations follow different linguistic patterns

  • Unclear why 15 years was selected as marker for understanding differences in knowledge based on experience - was this arbitrary?

Resources

Menichetti J, Gerwing J, Borghi L, Gulbrandsen P, Vegni E. Saying "I Don't Know": A Video-Based Study on Physicians' Claims of No-Knowledge in Assisted Reproductive Technology Consultations. Front Psychol. 2021;11:611074. Published 2021 Jan 12. doi:10.3389/fpsyg.2020.611074

Rodriguez, CH. Children’s Hospitals Grapple With Young Covid ‘Long Haulers’. Kaiser Health News. Published March 3, 2021; accessed on March 4, 2021. https://khn.org/news/article/children-covid-long-hauler-clinics-pediatric-hospitals/