Managing Uncertainty in the Practice of Medicine

Managing Uncertainty in the Practice of Medicine


Medicine is a highly complex profession. Physicians are called upon to provide diagnoses, to come up with treatment plans, and to give prognoses about the disease course and outcomes of their patients. In clinical practice, they often encounter cases in which a patient presents with symptoms that are common to various conditions. To establish the actual cause, the physician must perform a differential diagnosis. This process involves gathering the individual’s medical history, carrying out a targeted exam, and ordering any additional tests that are necessary. Is it any wonder, then, that uncertainty should be a daily presence in physicians’ lives?

Decision analysis in medicine shows that there is a high level of uncertainty when the best decision that the physician may make is not immediately clear (that is, when many solutions are perceived as good) and when the problem is one that occurs infrequently or that requires a high degree of knowledge.

Having strategies to deal with uncertainty could be helpful, according to an editorial published in The American Journal of Medicine. The author, Daniel M. Lichtstein, MD, mentions aspects of daily clinical practice to which these strategies can be applied.

Acknowledge Uncertainty

Physicians are responsible for striving to do the best they can for their patients at all times, yet diagnostic dilemmas are common, and the preferred evaluation and treatment are not always clear. The most important step for physicians to take when dealing with uncertainty is to acknowledge it.

All physicians make errors. Some of these errors can be traced to not acknowledging uncertainty and to not having the humility or willingness to admit when they do not know something. Being humble enough to say, “I don’t know,” and to recognize when consultation with colleagues or consultants is indicated is critically important and is something that patients deserve.

Clinical Practice Strategies

Sharing uncertainty and taking a patient-centered approach to decision-making help to create open and trusting relationships with patients. Lichtstein writes, “I realized that by initially not sharing my uncertainty with my patients, it resulted in more stress and worry.”

Patients should always be instructed to call if their condition changes or worsens, and physicians should be specific about what the patient should look for and how to get in touch.

In addition, close follow-up is crucial in dealing with uncertainty. The correct diagnosis may become apparent as an illness evolves, and close follow-up increases the likelihood that a physician may recognize it.

If a patient is being discharged from the hospital and another physician (likely the patient’s primary care physician) is going to assume follow-up, that physician should be contacted directly, and any uncertainty regarding the patient’s condition or plans of care moving forward should be made clear. The same principle applies during a hospitalization as care is transitioned from one shift to another or from one physician to another.

When uncertain about the course a condition may take or how the patient may respond to treatment, a physician may feel that he or she is letting the patient down or is disappointing them in some way. But as Katrina Armstrong, MD, wrote in her article, “If You Can’t Beat It, Join It: Uncertainty and Trust in Medicine,” “The greatest comfort to a patient can be hearing that, regardless of clinical uncertainty, their physician will be with them no matter what the future brings.”

This article was translated from Univadis Italy.

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