When a patient visits a doctor’s office his brain is unpredictable, he will misinterpret or completely misunderstand at least 30 percent of what the doctor said.

Yeah, I mean every patient.

You can try using the teach back method or ask “is everything clear to you?”. But still, the patient will leave your office with some gaps in understanding. It is inevitable.

When the patient comes home and the pressure falls off then questions start to plague his mind. Not just the questions he forgets to ask, but also questions his family members and friends are asking him.

Suddenly the patient has more questions than answers in his head and the worm of uncertainty is born.

Worm of Uncertainty

This may look cool in the animation, but it really isn’t. The worm of uncertainty is the greatest enemy of the doctor-patient relationship. It causes fear, doubt, and misunderstanding.

When patients don’t understand the doctor’s advice or treatment proposals they are less likely to align with it and they become more fragile to:

  1. Consume therapy in a wrong, potentially dangerous way
  2. Leave therapy after meeting the first obstacle or problem
  3. Start looking for another doctor or alternative solutions

All three of these options are devastating for a doctor-patient relationship. They either lay seeds of distrust or they ruin the relationship completely.

Fortunately, there is an ultimate solution for this problem – give the patient time to ask questions.

Before you say, “I know this but…read this post all the way to the end.

I will share a unique approach “Doctor W” used to enhance communication and remove the worm of uncertainty from my very own head.

A Different Way to Ask/Answer Questions

The obvious way to address patient questions is to include questions as a regular part of the physical examination routine. It’s a solid option, especially if you have enough time to conduct an exam.

This option will address some current questions and give the patient a sense that you care about him or her. But in the end, it won’t help much in solving uncertainty problems in the long term.

Even if patients come up with meaningful questions, which isn’t always the case, they probably won’t understand every answer correctly. Also, those questions are just a fragment of their uncertainties, something they come up with in a few seconds in a highly stressful moment.

Contrary to this traditional approach, “Doctor W” used a somewhat different tactic.

Medicine For Worm

He used physical exam just to get know me and my situation better. Additionally, he decided to devote special time and effort just to asking and answering all the important questions.

He did it in a way that was smart and professional, fully mindful of the fact we’re both busy people.

BONUS: If you want to learn how one of the best orthopedic surgeons in Europe lead his patient from first contact to post surgery phase, click here to get all moves and unique patient perspective with real life examples.

 Remote questions and answers

Instead of organizing live consultations or scheduled phone calls, he decided to use e-mail as one of the proven methods for communicating with patients.

They say you cannot show compassion and care if you don’t speak with someone in person but that is complete BT. The best way to show care is to be with your patient when they need you the most. The best way to show care is to be with your patient when they need you the most. Click To Tweet

Here is a smart way to do it.


To start with remote Q&A-s, you need to take the first step.

Obviously you need to exchange e-mails with your patient if you already have not done so.

But instead of just saying, “You can contact me by e-mail” to your patients, send them an initiation e-mail a few days after the visit. In this message, encourage them to dive deep in their brain and ask all the important questions based on that.

Look at the initiation e-mail message that my doctor sent me a few days after having me visit him:

FollowUp from DR W

When he sent me this e-mail, he gave me permission to ask.

Not just to ask my doctor something, but to also take enough time to ask myself about what makes me feel concerned, confused, or scared.

This is a major goal of the initiation e-mail message.

Patient aren’t usually able to come up with questions in 60 seconds. He will consider everything, talk to his family, and come up with questions that are the most important to him in the current phase of the healing process.

As a doctor, you will get all the important questions in one place. They aren’t stuck in the patient’s head anymore, and now all you need to do is answer them.


After a couple of days, you will probably get a reply with five to fifteen questions from your patient.

Not all of them seem important, but answer them all anyways. It is hard to predict what drives an individual patient, especially if you aren’t personally connected with him or her.

If we get back to my own case of osteomyelitis (calcaneus) and Q&A communication with my doctor, here are some of the questions I asked:

Questions To Doctor

After two days I got an e-mail with answers from “Doctor W”:

Doctor Answers to Patient Questions

These e-mail answers resulted in a number of positive things. It helped me to understand different aspects of my current condition and the benefits of the doctor’s treatment proposal.

Also, it gave me direction about my current therapy and saved me from 20 days of unnecessary antibiotics.

“Doctor W’s” answers removed the worm of uncertainty from my mind and I moved step closer to accepting new surgery as a solution.


This tactic isn’t predetermined to be a one-time thing. It should not be associated only with cases involving surgery like mine.

As a matter of fact, it can be used in different phases of the healing process:

  • Pre-operative or Post-operative
  • After the initial visit or after a major change in therapy
  • To highlight important questions before the initial visit

Whenever your patient may be confused, or whenever you are confused also.

That’s right, it’s up to you.

You can also reverse the whole process. Instead of giving permission, you can ask for permission. Instead of answering patient questions, you can ask them to answer yours.

Does this really matters?

The experience with “Doctor W” has really changed my perception of how doctors and patients should communicate. Instead of being in a dilemma as per usual, I was clear about why, what, and how.

Later, I realized that I am not the only one who cared about being informed. Most of the patients do; no one feels comfortable with the worm of uncertainty in their mind.

Look at what patients of Cleveland Clinic said about what affects their satisfaction the most. As you can see, clarity in communication is a top priority, right behind sense of care.

If you want to keep patients at the top of the satisfaction scale, remote Q&As could be ideal for you:

  1. You show sense of care when you send initiation message (90% of doctors won’t do this for their patient).
  2. It unfolds all the important questions from patients and their families.
  3. All is written in an easy to use electronic form. Ready to share or read multiple times.

Most importantly, this isn’t another cheap trick to satisfy unrealistic patient needs. This tactic has a real impact to the bottom line.   

Better communication, better outcomes, happier doctors and patients. It is in essence, an undeniable win from any perspective.

Thank you for reading this piece all the way to the end. I would love to hear from you, do you have previous experience with Worm of Uncertainty? Did you find any effective way to deal with it?