Medical Uncertainty Revisited

2014 ◽  
pp. 409-425 ◽  
Author(s):  
Renée C. Fox
Keyword(s):  
Medical Uncertainty

scholarly journals How Physicians Manage Medical Uncertainty: A Qualitative Study and Conceptual Taxonomy

2021 ◽  
pp. 0272989X2199234
Author(s):  
Paul K. J. Han ◽  
Tania D. Strout ◽  
Caitlin Gutheil ◽  
Carl Germann ◽  
Brian King ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Qualitative Study ◽  
Management Strategies ◽  
Acute Care Hospital ◽  
Uncertainty Management ◽  
Care Hospital ◽  
Convenience Sample ◽  
Medical Specialties ◽  
Tolerance Of Uncertainty ◽  
Medical Uncertainty

Background Medical uncertainty is a pervasive and important problem, but the strategies physicians use to manage it have not been systematically described. Objectives To explore the uncertainty management strategies employed by physicians practicing in acute-care hospital settings and to organize these strategies within a conceptual taxonomy that can guide further efforts to understand and improve physicians’ tolerance of medical uncertainty. Design Qualitative study using individual in-depth interviews. Participants Convenience sample of 22 physicians and trainees (11 attending physicians, 7 residents [postgraduate years 1–3), 4 fourth-year medical students), working within 3 medical specialties (emergency medicine, internal medicine, internal medicine–pediatrics), at a single large US teaching hospital. Measurements Semistructured interviews explored participants’ strategies for managing medical uncertainty and temporal changes in their uncertainty tolerance. Inductive qualitative analysis of audio-recorded interview transcripts was conducted to identify and categorize key themes and to develop a coherent conceptual taxonomy of uncertainty management strategies. Results Participants identified various uncertainty management strategies that differed in their primary focus: 1) ignorance-focused, 2) uncertainty-focused, 3) response-focused, and 4) relationship-focused. Ignorance- and uncertainty-focused strategies were primarily curative (aimed at reducing uncertainty), while response- and relationship-focused strategies were primarily palliative (aimed at ameliorating aversive effects of uncertainty). Several participants described a temporal evolution in their tolerance of uncertainty, which coincided with the development of greater epistemic maturity, humility, flexibility, and openness. Conclusions Physicians and physician-trainees employ a variety of uncertainty management strategies focused on different goals, and their tolerance of uncertainty evolves with the development of several key capacities. More work is needed to understand and improve the management of medical uncertainty by physicians, and a conceptual taxonomy can provide a useful organizing framework for this work.

The Anatomy of Uncertainty

2021 ◽  
pp. 31-58
Author(s):  
Paul K.J. Han
Keyword(s):  
Conceptual Framework ◽  
Three Dimensional ◽  
Rational Approach ◽  
Subjective Reality ◽  
Medical Uncertainty

Chapter 3 describes the anatomy of medical uncertainty, identifying key attributes that give it a three-dimensional conceptual shape, form, and structure. It characterizes uncertainty in terms of its (1) fundamental sources (root causes), (2) issues (substantive problems), and (3) loci (persons in whose minds uncertainty resides) and presents a conceptual framework that allows the variety of uncertainties in medicine to be classified and better understood. The chapter makes the case that in all of these ways, a three-dimensional conceptual framework can facilitate a more intentional, targeted, and rational approach to evaluating medical uncertainty. By providing a way of visualizing, ordering, and objectifying an otherwise invisible, disordered, subjective reality, the framework can ultimately enable clinicians and patients to better manage medical uncertainty.

scholarly journals Understanding Behavioral Intent to Participate in Shared Decision-making in Medically Uncertain Situations

2012 ◽  
Vol 51 (04) ◽  
pp. 301-308 ◽  
Author(s):  
K. Dunn ◽  
J. Zhang ◽  
C. E. Hsu ◽  
J. H. Holmes ◽  
R. M. Maffei
Keyword(s):  
Decision Making ◽  
Content Analysis ◽  
Shared Decision Making ◽  
Information Seeking ◽  
Health Informatics ◽  
Qualitative Content Analysis ◽  
Shared Decision ◽  
Behavioral Intent ◽  
Patient Interview ◽  
Medical Uncertainty

SummaryObjective: This article describes the process undertaken to identify and validate behavioral and normative beliefs and behavioral intent based on the Theory of Reasoned Action (TRA) and applied to men between the ages of 45 and 70 in the context of their participation in shared decision-making (SDM) in medically uncertain situations. This article also discusses the preliminary results of the aforementioned processes and explores potential future uses of this information that may facilitate greater understanding, efficiency and effectiveness of clinician-patient consultations.Materials and Methods: Twenty-five male subjects from the Philadelphia community participated in this study. Individual semi-structure patient interviews were conducted until data saturation was reached. Based on their review of the patient interview transcripts, researchers conducted a qualitative content analysis to identify prevalent themes and, subsequently, create a category framework. Qualitative indicators were used to evaluate respondents’ experiences, beliefs, and behavioral intent relative to participation in shared decision-making during medical uncertainty.Results: Based on the themes uncovered through the content analysis, a category framework was developed to facilitate understanding and increase the accuracy of predictions related to an individual’s behavioral intent to participate in shared decision-making in medical uncertainty. The emerged themes included past experience with medical uncertainty, individual personality, and the relationship between the patient and his physician. The resulting three main framework categories include 1) an individual’s Foundation for the concept of medical uncertainty, 2) how the individual Copes with medical uncertainty, and 3) the individual’s Behavioral Intent to seek information and participate in shared decision-making during times of medically uncertain situations.Discussion: The theme of Coping (with uncertainty) emerged as a particularly critical behavior/characteristic amongst the subjects. By understanding a subject’s disposition with regard to coping, researchers were better able to make connections between a subject’s prior experiences, their knowledge seeking activities, and their intent to participate in SDM. Despite having information and social support, the subjects still had to cope with the idea of uncertainty before determining how to proceed with regard to shared decision-making. In addition, the coping category reinforced the importance of information seeking behaviors and preferences for shared decision-making.Conclusions: This study applies and extends the field of behavioral and health informatics to assist medical practice and decision-making in situations of medical uncertainty. More specifically, this study led to the development of a category framework that facilitates the identification of an individual’s needs and motivational factors with regard to their intent to participate in shared decision-making in situations of medical uncertainty.

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