Abstract
BACKGROUND
Uncertainty shapes many decisions made by physicians everyday. Uncertainty and physicians’ inability to handle it may result in substandard care and unexplained variations in patterns of care.
OBJECTIVE
To describe socio-demographic and professional characteristics of reactions to uncertainty among physicians from all specialties, including physicians in training.
DESIGN
Cross-sectional postal survey.
PARTICIPANT
All physicians practicing in Geneva, Switzerland (n = 1,994).
MEASUREMENT
Reaction to medical care uncertainty was measured with the Anxiety Due to Uncertainty and Concern About Bad Outcomes scales. The questionnaire also included items about professional characteristics and work-related satisfaction scales.
RESULTS
After the first mailing and two reminders, 1,184 physicians responded to the survey. In univariate analysis, women, junior physicians, surgical specialists, generalist physicians, and physicians with lower workloads had higher scores in both scales. In multivariate models, sex, medical specialty, and workload remained significantly associated with both scales, whereas clinical experience remained associated only with concern about bad outcomes. Higher levels of anxiety due to uncertainty were associated with lower scores of work-related satisfaction, while higher levels of concern about bad outcomes were associated with lower satisfaction scores for patient care, personal rewards, professional relations, and general satisfaction, but not for work-related burden or satisfaction with income-prestige. The negative effect of anxiety due to uncertainty on work-related satisfaction was more important for physicians in training.
CONCLUSION
Physicians’ reactions to uncertainty in medical care were associated with several dimensions of work-related satisfaction. Physicians in training experienced the greatest impact of anxiety due to uncertainty on their work-related satisfaction. Incorporating strategies to deal with uncertainty into residency training may be useful.
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References
Rizzo JA. Physician uncertainty and the art of persuasion. Soc Sci Med. 1993;37:1451–9.
Hewson MG, Kindy PJ, Van Kirk J, et al. Strategies for managing uncertainty and complexity. J Gen Intern Med. 1996;11:481–5.
Griffiths F, Green E, Tsouroufli M. The nature of medical evidence and its inherent uncertainty for the clinical consultation: qualitative study. BMJ. 2005;330:511.
Geller G, Faden RR, Levine DM. Tolerance for ambiguity among medical students: implications for their selection, training and practice. Soc Sci Med. 1990;31:619–24.
Kassirer JP. Our stubborn quest for diagnostic certainty. A cause of excessive testing. N Engl J Med. 1989;320:1489–91.
Geller G, Tambor ES, Chase GA, Holtzman NA. Measuring physicians’ tolerance for ambiguity and its relationship to their reported practices regarding genetic testing. Med Care. 1993;31:989–1001.
Gerrity MS, DeVellis RF, Earp JA. Physicians’ reactions to uncertainty in patient care: a new measure and new insights. Med Care. 1990;28:724–36.
Pearson SD, Goldman L, Orav EJ, et al. Triage decisions for emergency department patients with chest pain: do physicians’ risk attitudes make the difference? J Gen Intern Med. 1995;10:557–64.
Poses RM, De Saintonge DM, McClish DK, et al. An international comparison of physicians’ judgments of outcome rates of cardiac procedures and attitudes toward risk, uncertainty, justifiability, and regret. Med Decis Mak. 1998;18:131–40.
Friedmann PD, Brett AS, Mayo-Smith MF. Differences in generalists’ and cardiologists’ perceptions of cardiovascular risk and the outcomes of preventive therapy in cardiovascular disease. Ann Intern Med. 1996;124:414–21.
Tubbs EP, Broeckel Elrod JA, Flum DR. Risk Taking and tolerance of uncertainty: implications for surgeons. J Surg Res. 2005.
Light D, Jr. Uncertainty and control in professional training. J Health Soc Behav. 1979;20:310–22.
Atkinson P. Training for certainty. Soc Sci Med. 1984;19:949–56.
Schor R, Pilpel D, Benbassat J. Tolerance of uncertainty of medical students and practicing physicians. Med Care. 2000;38:272–80.
Beresford EB. Uncertainty and the shaping of medical decisions. Hastings Cent Rep. 1991;21:6–11.
Allison JJ, Kiefe CI, Cook EF, et al. The association of physician attitudes about uncertainty and risk taking with resource use in a Medicare HMO. Med Decis Making. 1998;18:320–9.
van der Weijden T, van Bokhoven MA, Dinant GJ, et al. Understanding laboratory testing in diagnostic uncertainty: a qualitative study in general practice. Br J Gen Pract. 2002;52:974–80.
Goehring C, Bouvier Gallacchi M, Kunzi B, Bovier P. Psychosocial and professional characteristics of burnout in Swiss primary care practitioners: a cross-sectional survey. Swiss Med Wkly. 2005;135:101–8.
Goldberg R, Boss RW, Chan L, et al. Burnout and its correlates in emergency physicians: four years’ experience with a wellness booth. Acad Emerg Med. 1996;3:1156–64.
Lemkau J, Rafferty J, Gordon R, Jr. Burnout and career-choice regret among family practice physicians in early practice. Fam Pract Res J. 1994;14:213–22.
Ramirez AJ, Graham J, Richards MA, et al. Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet. 1996;347:724–8.
Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136:358–67.
Gerrity M, White KP, DeVellis RF, Dittus RS. Physicians’ reactions to uncertainty: refining the constructs and scales. Motiv Emot. 1995;19:175–91.
Gerrity M, Earp JA, DeVellis RF, Light DW. Uncertainty and professional work: perceptions of physicians in clinical practice. Am J Sociol. 1992;97:1022–51.
Bovier P, Perneger T. Predictors of work satisfaction among physicians. Eur J Public Health. 2003;13:299–305.
Konrad TR, Williams ES, Linzer M, et al. Measuring physician job satisfaction in a changing workplace and a challenging environment. SGIM Career Satisfaction Study Group. Society of General Internal Medicine. Med Care. 1999;37:1174–82.
Cleveland WS. Robust locally weighted regression and smoothing scatterplots. J Am Stat Assoc. 1979;74:829–36.
Perneger TV. What’s wrong with Bonferroni adjustments. BMJ. 1998;316:1236–8.
Hall KH. Reviewing intuitive decision-making and uncertainty: the implications for medical education. Med Educ. 2002;36:216–24.
Bovier PA, Martin DP, Perneger TV. Cost-consciousness among Swiss doctors: a cross-sectional survey. BMC Health Serv Res. 2005;5:72.
Fargason CA, Jr., Evans HH, Ashworth CS, Capper SA. The importance of preparing medical students to manage different types of uncertainty. Acad Med. 1997;72:688–92.
Acknowledgement
Parts of these results have been presented as a poster at the 74th meeting of the Swiss Society of Internal Medicine, May 10–12, 2006 in Lausanne, Switzerland. This study was funded by a grant from the Swiss National Science Foundation (3200-053377). The funding agency had no role in the design and conduct of the study, the interpretation or analysis of the data, or the approval the manuscript.
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Bovier, P.A., Perneger, T.V. Stress from Uncertainty from Graduation to Retirement—A Population-Based Study of Swiss Physicians. J GEN INTERN MED 22, 632–638 (2007). https://doi.org/10.1007/s11606-007-0159-7
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DOI: https://doi.org/10.1007/s11606-007-0159-7