Abstract
Background
The consequences of uncertainty are extensive with the potential to influence a multitude of issues such as patient expectations, diagnosis, treatment decisions, patient confidence and satisfaction and ultimately patient compliance.
Aims
To review the relevant literature pertaining to physician expressions of uncertainty and its effects on patients.
Methods
A search was conducted in July 2016 of electronic databases; PsycINFO, PsycARTICLES, MEDLINE and Embase. Key search terms included uncertainty, physician uncertainty, patient attitude, patient confidence and patient satisfaction. Other sources were obtained from reference lists. The eligibility of studies and data extracted were cross-checked with inclusion and exclusion criteria.
Results
The search yielded 14 studies and 4 were included for review. These studies yielded mixed results. In some studies patients preferred disclosure of uncertainty while in others such disclosure was negatively associated with patient confidence and satisfaction. This is at odds with the belief of theorists that uncertainty disclosure to patients is the crux of a successful doctor–patient relationship. The studies were, however, united in so far as the way in which the uncertainty was communicated to the patient was pivotal to patient responses to uncertainty.
Conclusions
Uncertainty is a ubiquitous feature of medicine and more research should examine how physician’s expressions of uncertainty affect patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Babrow AS, Kasch CR, Ford LA (1998) The many meanings of uncertainty in illness: toward a systematic accounting. Health Commun 10(1):1–23
Han PK, Klein WM, Arora NK (2011) Varieties of uncertainty in health care: a conceptual taxonomy. Med Decis Making 31(6):828–838
Johnson CG, Levenkron JC, Suchman AL, Manchester R (1988) Does physician uncertainty affect patient satisfaction? J Gen Intern Med 3(2):144–149
Henry MS (2006) Uncertainty, responsibility, and the evolution of the physician/patient relationship. J Med Ethics 32(6):321–323
Mishel MH (1981) The measurement of uncertainty in illness. Nurs Res 30(5):258–263
Gordon GH, Joos SK, Byrne J (2000) Physician expressions of uncertainty during patient encounters. Patient Educ Couns 40(1):59–65
Schneider A, Wübken M, Linde K, Bühner M (2014) Communicating and dealing with uncertainty in general practice: the association with neuroticism. PLoS One 9(7):e102780
Ghosh AK (2004) Dealing with medical uncertainty: a physician’s perspective. Minn Med 87(10):48–51
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Int Med 151:65–94
Politi MC, Clark MA, Ombao H, Légaré F (2011) The impact of physicians’ reactions to uncertainty on patients’ decision satisfaction. J Eval Clin Pract 17(4):575–578
Ghosh AK (2004) Understanding medical uncertainty: a primer for physicians. J Assoc Phys India 52:739–742
Srivastava R (2011) Dealing with uncertainty in a time of plenty. N Engl J Med 365(24):2252–2253
Ogden J, Fuks K, Gardner M, Johnson S, McLean M, Martin P, Shah R (2002) Doctors expressions of uncertainty and patient confidence. Patient Edu Couns 48(2):171–176
Hewson MG, Kindy PJ, Van Kirk J, Gennis VA, Day RP (1996) Strategies for managing uncertainty and complexity. J Gen Intern Med 11(8):481–485
Linn LS (1975) Factors associated with patient evaluation of health care. Milbank Mem Fund Q Health Soc 53(4):531–548
Murphy-Cullen CL, Larsen LC (1984) Interaction between the socio-demographic variables of physicians and their patients: its impact upon patient satisfaction. Soc Sci Med 19(2):163–166
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
No external funding.
Conflict of interest
Author A declares that he/she has no conflict of interest. Author B declares that he/she has no conflict of interest.
Ethical approval
This article does not contain any studies with human participants performed by any of the authors.
Appendix
Appendix
Study | Patient sample | Type of data | Study type | Outcome |
|---|---|---|---|---|
Johnson (1988) | Hospital clinic waiting list (n = 100) | Audiovisual recordings | Qualitative | Expressing uncertainty is detrimental to patient confidence and evaluation of the consultation. The manner in which uncertainty is disclosed affects patient satisfaction |
Ogden (2001) | General practitioners (n = 66) and their attending patients (n = 550) | Matched questionnaires | Qualitative | Physicians and patients agreed that expressions of uncertainty were detrimental to patient confidence. Verbal expressions were more detrimental than behavioural expressions |
Gordon (2000) | Review visits to a hospital clinic (n = 216) | Audio-taped dialogue | Qualitative | Physician expressions of uncertainty were associated with greater patient satisfaction when other specific physician verbal expressions were present. Uncertainty disclosure was associated with a greater doctor–patient rapport |
Politi (2010) | Cancer treatment clinic (n = 75) | Questionnaire telephone call | Qualitative | Physician expressions of uncertainty lead to greater patient decision satisfaction |
Rights and permissions
About this article
Cite this article
McGovern, R., Harmon, D. Patient response to physician expressions of uncertainty: a systematic review. Ir J Med Sci 186, 1061–1065 (2017). https://doi.org/10.1007/s11845-017-1592-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-017-1592-1