The pragmatics of diagnostic uncertainty: A closer look at hedges and shared understanding in diagnostic statements

Abstract 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.