You can’t know what you don’t know. Seems pretty obvious, but it’s something easily overlooked in medical decision making.

We make a lot of assumptions in healthcare, one of the biggest being that our patients can’t possibly understand information the way we do. So we end up talking down to our patients, or using jargon or euphemisms, and when we meet “resistance” to our message, we spiral in frustration and affix labels. In reality, it means we’re probably not communicating with our patients in the most effective, individualized way.

Sometimes this goes a step further. For example, we might assume that a patient with a diagnosis of dementia isn’t capable of understanding medical updates when in reality this is not true. When we go to assess capacity to make a specific decision, the patient might say “I don’t know what’s going on.” If he literally hasn’t been updated because someone with dementia couldn’t possibly comprehend what’s going on, then this could very well be a statement of fact and not a lack of insight.

You can’t know what you don’t know. Your patient may not want to know, and that’s a separate topic. But don’t assume a lack of insight based on bias or perceived “resistance” to your message.

Related: https://jamanetwork.com/journals/jama/article-abstract/2765421