I usually say in my clinical practice that “It´s better a bad certainty that the best of the uncertainties…”, mainly by the anxiety and uneasiness that doubt, indecision and dilema create. Our own uncertainty.

When a patient comes into any consultation, the physician doubts. Doubts about the expectations of the patient, the requests, the clinical diagnosis. Doubts about if test should be performanced and what are the most appropriate; doubts about the treatment to choose; doubts about the response to treatment in each patient…doubts, doubts, doubts.

In a society in which the exposure of our reality, the demand for answers and immediacy is forced, doctors must think about actions to propose to our patients. Society demands information (sometimes so voracious and ephemeral), action (not always proportionate or coherent) and reaction (serene attitudes or peacekeeping surprise us). And both patients and health care providers have to think about if carrying out tests provides or not really something positive about health. It is not always true.

A medicine based on the indiscriminate application of diagnostic tests, far from favouring a right or proper diagnosis, can confuse us, as well as generate logical anxiety about the unknown or uncertain of the requested test result. I think that a simple question put on the table by the health care professional would bring an extra dose of light on this uncertainty: what does this or that test give to the knowledge of our State of health and subsequent decision making? And it is not clear that diagnostic testing has “value-added” inherently in each of them. From various discussion forums, it puts into question an interventionist, aggressive and sometimes even iatrogenic medicine. We need to do test, but only missing that, those that are really necessary.T

he consultation should be an environment for sharing knowledge and concerns in both directions. The patient is more interested in recovering the health or deal with the fear of the disease. And the doctor is the main defender of this path.

Professionals and actors (patients) must be able to share the uncertainty of the diagnostic process and the decision on the tests or guidelines to follow. The doctor, from the light that gives knowledgement and the study of disease processes. The patient, from the joint responsibility in the decision, supported by a simple, accurate, adequate and easily understandable information.

Our duty as professionals is to be updated on the issues that we have to deal with. And the duty of the patients is to require professionals that they do so.

None are essential, but the effort to reduce the clinical variability depending on who we meet, should be an non-waivable objective.

The implementation of these attitudes will facilitate recoverying and extoling the human condition shared by professional and patients, above application of technology, which is necessary but by no means sufficient.

“Smile me, touch me, love me… because I have to put my health in your hands”.

José Ramón Garmendia
Family doctor, currently in the Admission and Clinical documentation  Service of the Complejo Asistencial Universitario de Palencia