Should Doctors Ever Admit “I’m Not Sure” to a Patient?

In medicine, certainty is comfort. Patients want answers, clear diagnoses, and confident treatment plans. But what happens when a physician — the person often seen as a symbol of authority — utters the phrase, “I’m not sure”?

Is it refreshing honesty or unsettling vulnerability? A sign of weakness, or a marker of integrity?

Doctors are trained to provide certainty. But in clinical reality, uncertainty is everywhere. So the real question isn’t whether doctors face uncertainty — they do, daily — but whether it’s acceptable, or even ethical, to express that uncertainty out loud.

This article explores that small but powerful phrase — “I’m not sure” — and how it can impact patient care, medical ethics, and the physician-patient relationship.

The Culture of Certainty in Medicine

From day one in medical school, doctors are trained to appear confident. Exams reward precise answers. Clinical rounds favor quick assessments. Patients seek reassurance, and mentors admire clarity. There’s not much room for doubt.

Uncertainty is seen as weakness — something you cover up with clinical jargon or mask behind an ordered CT scan.

This creates a deep culture of performative certainty. Doctors may not know the answer, but they feel compelled to speak as if they do. Admitting doubt becomes a quiet act of defiance.

But what happens when pretending starts to do more harm than good?

Why Saying “I’m Not Sure” Feels Risky

Admitting uncertainty feels like stepping off a cliff. Doctors often fear it for several reasons:

• It might weaken patient trust, pushing them to seek second opinions
  
  
• It can be seen as incompetence, especially among juniors or those facing bias (e.g., women, minorities)
  
  
• There’s concern about legal exposure — even if it’s unfounded
  
  
• It’s emotionally uncomfortable — both for the one saying it and the one hearing it
  

So instead of saying “I’m not sure,” many doctors default to vague language, excessive testing, or oversimplified explanations.

But often, these behaviors are more about protecting ourselves than helping the patient.

But Here’s the Truth: Uncertainty Is Inevitable

Medicine is not mathematics. Clinical decisions are rarely binary. Physicians constantly navigate:

• Incomplete histories
  
  
• Inconclusive or conflicting test results
  
  
• Overlapping symptoms
  
  
• Rare or newly emerging conditions
  
  
• Variability in how patients respond to treatments
  

Even the most evidence-based care lives in a world of probability, not certainty.

So instead of fearing uncertainty, we should normalize it — and teach doctors how to communicate it effectively.

What Happens When Doctors Fake Certainty

When physicians pretend to know what they don’t, it can backfire in several ways:

• Overtesting: Ordering unnecessary investigations to compensate for doubt
  
  
• Overdiagnosing: Assigning labels that don’t fully match, just to fill the silence
  
  
• Rushed decision-making: Making premature choices without fully weighing options
  
  
• Loss of trust: When patients eventually sense they were misled or under-informed
  

Trying to shield patients from discomfort often leads to more harm, not less. A calm, transparent “I’m not sure” may actually be more therapeutic than confident misinformation.

Can “I’m Not Sure” Build Trust?

In many cases, yes.

Research and patient interviews consistently show that people value honesty. They don’t expect perfection — they expect transparency. When uncertainty is shared appropriately, patients often feel more respected, not less.

What matters is not the uncertainty itself but how it’s framed:

• Be clear about what’s known and unknown
  
  
• Outline the next steps
  
  
• Reassure patients that you’re still in control of their care
  
  
• Emphasize collaboration and ongoing evaluation
  

Saying “I’m not sure, but here’s what we’ll do” invites patients into a partnership — not just a transaction.

How Patients React to Uncertainty (It Depends on How You Say It)

The impact of “I’m not sure” hinges on delivery, not just content.

• A composed tone suggests reflection, not fear
  
  
• Good eye contact shows engagement and confidence
  
  
• Providing context (“This is a rare presentation”) helps patients feel reassured
  
  
• Offering action plans or referrals reinforces commitment to care
  

Patients can tolerate ambiguity if they trust the person guiding them through it. And trust grows when doctors communicate openly, rather than hiding behind false certainty.

When You Should Say “I’m Not Sure”

There are situations where voicing uncertainty is not only acceptable — it’s therapeutic:

• When dealing with rare or undifferentiated conditions
  
  
• When guidelines conflict, such as with long COVID or cancer screening
  
  
• In cases of emerging diseases or treatments
  
  
• When complex comorbidities make standard approaches risky
  

In these scenarios, patients often prefer a doctor who admits complexity over one who pretends everything is black and white.

When You Shouldn’t Say It (Or Not Yet)

However, not every moment is the right time for “I’m not sure.”

• Emergencies: During acute events like trauma or cardiac arrest, decisiveness matters
  
  
• Initial visits: When rapport hasn’t yet been built, ambiguity can create mistrust
  
  
• Without next steps: Simply stating “I don’t know” without offering a plan can breed fear
  

Clinical judgment is essential. Sometimes it’s better to say, “Let me get more information and we’ll talk again” — rather than leaving a patient adrift in uncertainty.

What to Say Instead (But Still Be Honest)

If the phrase “I’m not sure” feels too stark, there are alternatives that maintain transparency while preserving confidence:

• “There are a few possibilities I want to consider further.”
  
  
• “This isn’t a typical presentation, so I want to explore all the angles.”
  
  
• “Medicine doesn’t have a single answer here, but we’ll work through this together.”
  
  
• “I’m going to consult a colleague who specializes in this — we’ll get you the best input.”
  

These statements don’t avoid truth. They elevate it by pairing it with leadership.

Teaching Uncertainty in Medical Education

One major flaw in traditional medical training is the overemphasis on knowing the right answer.

But medicine is evolving. Many newer curricula now incorporate:

• The ethics of diagnostic humility
  
  
• Case-based learning with ambiguous outcomes
  
  
• Simulation scenarios that reward thoughtful, not just fast, answers
  
  
• Reflective writing on uncertainty and decision-making
  

Future doctors need more than knowledge. They need tools for communicating doubt, making shared decisions, and staying calm amid ambiguity.

The Power of Saying “I Don’t Know, But I’ll Find Out”

This is one of the most powerful phrases in medicine.

It shows humility without helplessness. It demonstrates effort, integrity, and teamwork. And it reassures patients that they’re not alone in the unknown.

It doesn’t diminish your credibility — it deepens it.

Patients remember when a doctor goes the extra mile to get it right. That effort, not ego, builds loyalty.

The Ethical Imperative of Honesty

Honesty is more than a virtue. It’s a clinical and legal requirement.

Expressing uncertainty isn’t just about emotional transparency. It:

• Respects the patient’s right to informed consent
  
  
• Helps prevent unnecessary interventions
  
  
• Protects against false reassurance or missed diagnoses
  
  
• Models professional integrity
  

In an age where misinformation is rampant, medical truth-telling is a necessary counterforce — even when the truth is “we don’t know yet.”

Final Thought: Knowing When Not to Know

Every doctor faces a decision: perform certainty, or practice honesty. The former might feel safer in the moment. The latter often serves the patient better in the long run.

Saying “I’m not sure” is not an act of failure. It’s an act of respect — for the science, for the complexity, and for the patient in front of you.

So yes, doctors should say it.

But they should say it wisely — with purpose, with empathy, and with a plan to move forward.

Because patients don’t want perfect doctors. They want real ones