“Could” is a word I would do without if I had my way!  Unfortunately, my patients love it! 

“Doc, could my headache be from stress?”

“Doc, could my husband be suffering from depression?”

“Doc, could my son have ADD?”

“Doc, could …?”  is a question I hear multiple times a day.  The funny thing is the answer is always the same.  Realistically, anything “could” be true.  So every time a patient asks the question, “could,” the answer is yes. 

“Yes, your headache could be from stress.”

“Yes, your husband could be suffering from depression.”

“Yes, your son could have ADD.”

Unfortunately, the “could” question often mislead my patients.  While the answer to a problem could be stress, depression, or ADD, often those are unlikely sources of the problem at hand.  Explaining why they could, but are unlikely, is time consuming and stressful for the patient and the doctor.  I particularly hate when a parent asks the “could” question in front of their child.  It is not uncommon to see fear immediately consume the patient’s face.

The question my patients should be asking is, “Doc, what is the probability that stress, depression, or ADD is the problem?”  Differential diagnoses are based on probabilities.  A differential diagnosis is a list of the probable causes for an illness ranked from most likely to least likely or most dangerous to least dangerous.

Knowing what my patients’ concerns are is critical.  Cyberchondria is real and the internet stirs up trouble on a regular basis.  Learning to avoid the word “could,” and using “probable” instead, helps allay a lot of fears!

Could this article help you find the answer to what’s bothering you?  I hope so!

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