Correct, but not reassuring

Koki Kato is a GP, educator, and GP practice director in Japan with interests in medical generalism and narrative practice.

I recently bought a new car.

The old one was traded in, the paperwork was signed, and I assumed the matter was finished.

Then a vehicle tax bill arrived in my name.

That was odd. The dealership had already taken ownership of the car, so I should not have been responsible for the tax. I contacted them and was reassured that everything would be dealt with.

A few days later, I was told that the tax had been paid.

Problem solved.

Then another letter arrived.

This one appeared to be a revised tax notice. By now, I was confused. Had the tax really been paid? Was I supposed to do something? What would happen if I ignored the letter?

Again, I contacted the dealership.

Again, I was reassured.

“Don’t worry about it.”

As it turned out, they were right. Different administrative processes had crossed paths, generating paperwork that no longer required any action from me. Nothing further needed to be done.

Yet I noticed something interesting.

Even after being given the correct answer, I still felt uneasy.

At first, I attributed this to the complexity of the tax system. But that was not really the problem.

The real issue was that I was not approaching the situation neutrally.

Several months earlier, there had been another misunderstanding during the purchase process. It was eventually resolved, but it left a trace. By the time these letters arrived, I was already carrying a quiet uncertainty about whether the information I received could be trusted.

The dealership and I were not starting from the same place.

As GPs, we often imagine that consultations begin with the problem in front of us. A symptom. A diagnosis. A test result.

But perhaps consultations rarely begin there.

Patients arrive carrying stories from previous encounters. Sometimes those stories involve feeling dismissed. Sometimes they involve being frightened by a missed diagnosis. Sometimes they involve years of being known and cared for by a trusted clinician.

Whatever the story, it shapes how new information is heard.

In a recent paper, colleagues and I described this phenomenon as tacit framing: the assumptions and interpretations people bring into situations before any conversation begins.¹ Looking back, my reaction to the tax notice makes more sense. The issue was not simply whether the dealership’s explanation was correct. It was whether that explanation could find a place within the story I was already carrying.

This experience also reminded me of another lesson.

Correct answers do not necessarily restore normality.

In medicine, we often provide answers. We diagnose an illness. We explain a test result. We reassure the patient that nothing serious has been found.

Sometimes we even say, in one form or another, “Don’t worry about it.”

And yet patients may leave still worried.

Not because they doubt our expertise, but because the answer itself does not resolve the disruption that illness has created in their lives.

What I wanted from the dealership was not simply a conclusion. I wanted an explanation that connected the various pieces of the story together. Why had the letters arrived? Why did they appear contradictory? Why was no action needed?

Only when the situation made sense could I stop thinking about it.

Perhaps patients need something similar.

Joanne Reeve argues that medical care should help create a tailored understanding of patients’ illness-in-context, rather than simply provide biomedical explanations.² That phrase resonates with me. Understanding is not something that clinicians hand over. It is something that is built together.

Before we can reassure, we may need to understand what story the patient is already living inside.

Only then can our explanations become meaningful.

The tax notice was, in the end, a trivial inconvenience. But it left me wondering how often my own patients hear a correct explanation while still carrying unanswered questions.

And how often reassurance fails not because it is wrong, but because understanding has not yet been built.

Deputy editor’s note- see also: https://bjgplife.com/how-can-we-understand-illness-the-pillar-of-person-centred-care/

References

1. Kato K, Miyachi J, Shimazono Y. Using ethnographic fieldwork to cultivate situational awareness. Educ Prim Care. 2026. DOI: 10.1080/14739879.2026.2633733

2. Reeve J. Medical Generalism, Now!: Reclaiming the Knowledge Work of Modern Practice. Boca Raton (FL): CRC Press; 2025. Chapter 1, Principles of whole person medicine; p. 1–20.

Featured photo by Ryul Davidson on Unsplash