How should clinicians handle an 'I' statement in practice?

• A. Dismiss the uncertainty and proceed with the test.
• B. Discuss uncertainties with patients and consider awaiting new evidence or alternative approaches.
• C. Immediately escalate to specialty referral.
• D. State that there is no uncertainty and end the discussion.

Answer: (B)

An I statement means there isn’t enough evidence to judge the balance of benefits and harms for a service. The best way to handle this is to be open about the uncertainty with the patient, explain what is known and what isn’t, and engage in shared decision making. Discuss the possible benefits and harms, outline available alternatives or different approaches, and consider whether it makes sense to wait for new evidence, pursue a different strategy with clearer evidence, or monitor and reassess over time. This approach respects patient values, avoids over- or under-treatment, and creates a clear plan for follow-up or next steps.