What We’ve Said

What we’ve said about Diagnostic uncertainty

5 points from 3 episodes, newest first

Also searched as diagnostic humility

In short

Certainty is not the goal: the symptom picture is a cloud, and more experience brings more uncertainty, not less. Hold a working theory, keep gathering evidence, and tell patients plainly what is on your differential and that time will tell.

How we think about it

  1. Recognize that the symptom picture is a cloud, and on that basis accept that you will not be certain. Uncertainty is wisdom.

    “So the cloud recognizing that it's a cloud and then saying on that basis, we are not going to be able to be certain. Uncertainty is wisdom”
    37:48How to Diagnose Bipolar Disorder with Dr. Phelps: Hypomania, Mixed States & the Clues DSM MissesSep 2026Guest episode

  2. Never say never. The stance is not "you absolutely don't have this" but "my working theory is this, and we will keep screening, monitoring and watching for what would change it."

    “a good clinician, their motto should be never say never, right? It's not, you absolutely don't have this. It's that my working theory is currently this, but we're going to continue to screen, monitor, and watch out for XYZ”
    46:27Lindsay Clancy Trial: A Forensic Psychiatrist Explains Psychosis, Malingering, & the Insanity DefenseSep 2026

  3. Collect a full range of evidence rather than relying on one story or one event.

    “You're collecting a full range of evidence, not just relying on this one story or this one event”
    29:13How to Diagnose Bipolar Disorder with Dr. Phelps: Hypomania, Mixed States & the Clues DSM MissesSep 2026

Talking to patients

  1. You do not have to commit to a diagnosis at the first meeting. Tell the patient what is on your differential and why, and that time is the only thing that will tell you the actual diagnosis.

    “You can say, this is what's on my differential. This is why I think that. And time is the only thing that's going to tell us what the actual diagnosis is”
    13:37The Best Bipolar Medication Review From The Best Bipolar ExpertJan 2025

  2. With more experience, uncertainty goes up, not down. Say so near the end of an intake: one 45-minute conversation is not enough to name all of someone's problems.

    “as I get more and more experienced, the amount of uncertainty I have goes up and up. And the amount of times that I communicate to patients, I say almost at the end of every intake, I wish I could talk to someone for 45 minutes and tell them all their problems”
    10:05How to Diagnose Bipolar Disorder with Dr. Phelps: Hypomania, Mixed States & the Clues DSM MissesSep 2026

From these episodes

Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.

Educational content only. Everything here is what was said on the Psychofarm podcast, for clinicians. It is not medical advice and not a substitute for clinical judgment, current labeling or guidelines. An episode reflects what we thought when we recorded it, so check anything before you rely on it.