Dealing with Uncertainty

what are the different sources of clinical uncertainty (7)?

• incomplete information: patient not present with all symptoms or tests may not be available

• ambiguity of symptoms: many conditions can present with similar symptoms

• evolving conditions: clinical presentation can change over time

• patient preferences and communication: patient’s description of symptoms or preferences may be unclear

• knowledge gap: even experienced clinicians can face situations they are unsure about

• practical: systems and processes of care, skills and competencies

• personal: relationships with patients, colleagues and the organisation

what are the different elements of clinical uncertainty?

• probabilities: estimating disease likelihood and predicting future events

• ambiguity: interpreting incomplete or conflicting information

• complexity: reconciling multiple interdependencies

what are the factors influencing experience of uncertainty?

• personal characteristics: personality traits, cognitive skills, experience

• clinical context: multimorbidities, patient expectations

• affect: evoked emotions, cognitive dissonance

• sociocultural factors: group norms, habits, rituals

what are the different types of clinician responses to uncertainty?

• cognitive:

  • positive: acknowledgment, perceived opportunity to learn, confidence

  • negative: threat, vulnerability, doubt

• emotional:

  • positive: calm, courage, curiosity, hope

  • negative: worry, fear, aversion, disengagement

• behavioural:

  • positive: action, information seeking, proactive approach

  • negative: avoidance, inaction, decision deferral

what are the different strategies for managing uncertainty (6)?

• clinical reasoning frameworks: using systematic approaches e.g. ruling our red flags, using diagnostic criteria

• shared decision making: collaborating with patients, explaining uncertainty and involving them in decisions

• consulting more experiences colleagues or clinical guidelines

• managing personal bias: being aware of and addressing cognitive biases

• reflecting practice: regularly reflecting on clinical experiences to learn from uncertainties

• patient safety: always lean on the side of caution when patient safety is at risk