Skip to content
Licensed Unlicensed Requires Authentication Published online by De Gruyter December 21, 2021

Diagnostic statements: a linguistic analysis of how clinicians communicate diagnosis

Maria R. Dahm ORCID logo and Carmel Crock
From the journal Diagnosis



To investigate from a linguistic perspective how clinicians deliver diagnosis to patients, and how these statements relate to diagnostic accuracy.


To identify temporal and discursive features in diagnostic statements, we analysed 16 video-recorded interactions collected during a practice high-stakes exam for internationally trained clinicians (25% female, n=4) to gain accreditation to practice in Australia. We recorded time spent on history-taking, examination, diagnosis and management. We extracted and deductively analysed types of diagnostic statements informed by literature.


Half of the participants arrived at the correct diagnosis, while the other half misdiagnosed the patient. On average, clinicians who made a diagnostic error took 30 s less in history-taking and 30 s more in providing diagnosis than clinicians with correct diagnosis. The majority of diagnostic statements were evidentialised (describing specific observations (n=24) or alluding to diagnostic processes (n=7)), personal knowledge or judgement (n=8), generalisations (n=6) and assertions (n=4). Clinicians who misdiagnosed provided more specific observations (n=14) than those who diagnosed correctly (n=9).


Interactions where there is a diagnostic error, had shorter history-taking periods, longer diagnostic statements and featured more evidence. Time spent on history-taking and diagnosis, and use of evidentialised diagnostic statements may be indicators for diagnostic accuracy.

Corresponding author: Dr. Maria R. Dahm, Senior Research Fellow, Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, The Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Canberra, ACT 2601, Australia, Phone: +61261254027, E-mail:


The authors wish to thank all participants and organisers of the mock AMC examination for their generous support for this project. The authors wish to thank Laura Chien for editorial comments.

  1. Research funding: Part of this project was funded through the Macquarie University New Staff Grant (2013).

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: Ethical approval was provided by the Macquarie University Human Research Ethics Committee (5201833543844).


1. Ofri, D. When we do harm. Boston: Beacon Press; 2020.Search in Google Scholar

2. Scott, IA, Crock, C. Diagnostic error: incidence, impacts, causes and preventive strategies. Med J Aust 2020;213:1–6, in Google Scholar

3. Bureau of Infrastructure and Transport Research Economics. Road Safety Statistics; 2020. in Google Scholar

4. Moran, K, Jammal, W. Avant research reveals factors underlying diagnostic error claims; 2018. in Google Scholar

5. Dahm, MR, Williams, M, Crock, C. ‘More than words’ – interpersonal communication, cognitive bias and diagnostic errors. Patient Educ Couns 2022;105:252–6 in Google Scholar

6. National Academies of Science Engineering & Medicine (NASEM). Improving diagnosis in health care. Washington DC: NASEM; 2015.Search in Google Scholar

7. Cooke, G. A is for aphorism Is it true that ‘a careful history will lead to the diagnosis 80% of the time’? Aust Fam Physician 2020;7: 534.Search in Google Scholar

8. Hampton, JR, Harrison, MJ, Mitchell, JR, Prichard, JS, Seymour, C. Relative contributions of history-taking, physical examination, and laboratory investigation to diagnosis and management of medical outpatients. Br Med J 1975;2:486–9, in Google Scholar

9. Peterson, MC, Holbrook, JH, Von Hales, D, Smith, NL, Staker, LV. Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. West J Med 1992;156:163–5, in Google Scholar

10. Roshan, M, Rao, AP. A study on relative contributions of the history, physical examination and investigations in making medical diagnosis. J Assoc Physicians India 2000;48:771–5.Search in Google Scholar

11. Lang, F, Floyd, MR, Beine, KL, Buck, P. Sequenced questioning to elicit the patient’s perspective on illness: effects on information disclosure, patient satisfaction, and time expenditure. Fam Med 2002;34:325–30.Search in Google Scholar

12. Giardina, TD, Haskell, H, Menon, S, Hallisy, J, Southwick, FS, Sarkar, U, et al.. Learning from patients’ experiences related to diagnostic errors is essential for progress in patient safety. Health Aff Millwood 2018;37:1821–7, in Google Scholar

13. National Quality Forum. Improving diagnostic quality and safety/reducing diagnostic error: measurement considerations – final report; 2020. in Google Scholar

14. Braddock, CH3rd, Snyder, L. The doctor will see you shortly. The ethical significance of time for the patient-physician relationship. J Gen Intern Med 2005;20:1057–62, in Google Scholar

15. Heritage, J, McArthur, A. The diagnostic moment: a study in US primary care. Soc Sci Med 2019;228:262–71, in Google Scholar

16. Peräkylä, A. Communicating and responding to diagnosis. In: Maynard, DW, Heritage, J, editors Communication in medical care: interaction between primary care Physicians and patients. Cambridge: Cambridge University Press; 2006. 214–47 pp.10.1017/CBO9780511607172.010Search in Google Scholar

17. Heritage, J, Stivers, T. Online commentary in acute medical visits: a method of shaping patient expectations. Soc Sci Med 1999;49:1501–17, in Google Scholar

18. Roberts, C, Sarangi, S. Theme-oriented discourse analysis of medical encounters. Med Educ 2005;39:632–40, in Google Scholar PubMed

19. Australian Medical Council (AMC). Standard Pathway. Standard Pathway; 2020. in Google Scholar

20. Bagheri, H, Ibrahim, NA, Habil, H. The structure of clinical consultation: a case of non-native speakers of English as participants. J Glob Health Sci 2015;7:249, in Google Scholar

21. Byrne, PS, Long, BE. Doctors talking to patients: a study of the verbal behavior of general practitioners consulting in their surgeries. London: H.M.S.O.; 1976.Search in Google Scholar

22. Heritage, J, Maynard, DW. Communication in medical care. Cambridge: Cambridge University Press; 2006.10.1017/CBO9780511607172Search in Google Scholar

23. Hsieh, H-F, Shannon, SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277–88, in Google Scholar

24. Connelly, LM. Trustworthiness in qualitative research. Medsurg Nurs 2016;25:435–6.Search in Google Scholar

25. Seaburn, DB, Morse, D, McDaniel, SH, Beckman, H, Silberman, J, Epstein, R. Physician responses to ambiguous patient symptoms. J Gen Intern Med 2005;20:525–30, in Google Scholar

26. Peräkylä, A. Authority and accountability: the delivery of diagnosis in primary health care. Soc Psychol Q 1998:301–20.10.2307/2787032Search in Google Scholar

27. Horsky, J, Suh, EH, Sayan, O, Patel, V. Uncertainty, case complexity and the content of verbal Handoffs at the Emergency Department. AMIA Annu Symp Proc 2015;2015:630–9.Search in Google Scholar

28. Atkins, S, Roberts, C, Hawthorne, K, Greenhalgh, T. Simulated consultations: a sociolinguistic perspective. BMC Med Educ 2016;16:1–9, in Google Scholar

29. Gordon, GH, Joos, SK, Byrne, J. Physician expressions of uncertainty during patient encounters. Patient Educ Couns 2000;40:59–65, in Google Scholar

30. Bhise, V, Rajan, SS, Sittig, DF, Morgan, RO, Chaudhary, P, Singh, H. Defining and measuring diagnostic uncertainty in medicine: a systematic review. J Gen Intern Med 2018;33:103–15, in Google Scholar PubMed PubMed Central

31. Elstein, AS. Thinking about diagnostic thinking: a 30-year perspective. Adv Health Sci Educ Theory Pract 2009;14(suppl 1):7–18, in Google Scholar PubMed

32. Graber, ML. The incidence of diagnostic error in medicine. BMJ Qual Saf 2013;22(suppl 2):ii21–7, in Google Scholar PubMed PubMed Central

33. Stokoe, E. The (In)Authenticity of simulated talk: comparing role-played and actual interaction and the implications for communication training. Res Lang Soc Interact 2013;46:165–85, in Google Scholar

34. Atkins, S. Assessing health professionals’ communication through role-play: an interactional analysis of simulated versus actual general practice consultations. Discourse Stud 2019;21:109–34, in Google Scholar

Supplementary Material

The online version of this article offers supplementary material (

Received: 2021-06-18
Accepted: 2021-10-29
Published Online: 2021-12-21

© 2021 Walter de Gruyter GmbH, Berlin/Boston