Skip to main content

Stress from Uncertainty from Graduation to Retirement—A Population-Based Study of Swiss Physicians

Journal of General Internal Medicine volume 22, pages 632–638 (2007)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Figure 1

References

  1. Rizzo JA. Physician uncertainty and the art of persuasion. Soc Sci Med. 1993;37:1451–9.

    PubMed  Article  CAS  Google Scholar 

  2. Hewson MG, Kindy PJ, Van Kirk J, et al. Strategies for managing uncertainty and complexity. J Gen Intern Med. 1996;11:481–5.

    PubMed  Article  CAS  Google Scholar 

  3. 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.

    PubMed  Article  Google Scholar 

  4. 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.

    PubMed  Article  CAS  Google Scholar 

  5. Kassirer JP. Our stubborn quest for diagnostic certainty. A cause of excessive testing. N Engl J Med. 1989;320:1489–91.

    PubMed  CAS  Article  Google Scholar 

  6. 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.

    PubMed  Article  CAS  Google Scholar 

  7. 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.

    PubMed  Article  CAS  Google Scholar 

  8. 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.

    PubMed  Article  CAS  Google Scholar 

  9. 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.

    CAS  Google Scholar 

  10. 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.

    PubMed  CAS  Google Scholar 

  11. Tubbs EP, Broeckel Elrod JA, Flum DR. Risk Taking and tolerance of uncertainty: implications for surgeons. J Surg Res. 2005.

  12. Light D, Jr. Uncertainty and control in professional training. J Health Soc Behav. 1979;20:310–22.

    PubMed  Article  Google Scholar 

  13. Atkinson P. Training for certainty. Soc Sci Med. 1984;19:949–56.

    PubMed  Article  CAS  Google Scholar 

  14. Schor R, Pilpel D, Benbassat J. Tolerance of uncertainty of medical students and practicing physicians. Med Care. 2000;38:272–80.

    PubMed  Article  CAS  Google Scholar 

  15. Beresford EB. Uncertainty and the shaping of medical decisions. Hastings Cent Rep. 1991;21:6–11.

    PubMed  CAS  Google Scholar 

  16. 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.

    PubMed  Article  CAS  Google Scholar 

  17. 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.

    PubMed  Google Scholar 

  18. 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.

    PubMed  Google Scholar 

  19. 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.

    PubMed  CAS  Article  Google Scholar 

  20. 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.

    PubMed  CAS  Google Scholar 

  21. 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.

    PubMed  Article  CAS  Google Scholar 

  22. 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.

    PubMed  Google Scholar 

  23. Gerrity M, White KP, DeVellis RF, Dittus RS. Physicians’ reactions to uncertainty: refining the constructs and scales. Motiv Emot. 1995;19:175–91.

    Article  Google Scholar 

  24. 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.

    Article  Google Scholar 

  25. Bovier P, Perneger T. Predictors of work satisfaction among physicians. Eur J Public Health. 2003;13:299–305.

    PubMed  Article  Google Scholar 

  26. 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.

    PubMed  Article  CAS  Google Scholar 

  27. Cleveland WS. Robust locally weighted regression and smoothing scatterplots. J Am Stat Assoc. 1979;74:829–36.

    Article  Google Scholar 

  28. Perneger TV. What’s wrong with Bonferroni adjustments. BMJ. 1998;316:1236–8.

    PubMed  CAS  Google Scholar 

  29. Hall KH. Reviewing intuitive decision-making and uncertainty: the implications for medical education. Med Educ. 2002;36:216–24.

    PubMed  Article  Google Scholar 

  30. Bovier PA, Martin DP, Perneger TV. Cost-consciousness among Swiss doctors: a cross-sectional survey. BMC Health Serv Res. 2005;5:72.

    PubMed  Article  Google Scholar 

  31. 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.

    PubMed  Article  Google Scholar 

Download references

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.

Conflict of Interest

None disclosed.

Author information

Affiliations

  1. Department of Community Medicine, Medical Outpatient Clinic, University Hospitals of Geneva, 24 Micheli-du-Crest, CH-1211, Geneva, Switzerland

    Patrick A. Bovier MD, MPH

  2. Quality of Care Service, University Hospitals of Geneva, and Institute of Social and Preventive Medicine, University of Geneva, Geneva, Switzerland

    Thomas V. Perneger MD, PhD

Authors
  1. Patrick A. Bovier MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas V. Perneger MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patrick A. Bovier MD, MPH.

Appendix

Appendix

Table 4 Original English and French Translation of the Items Measuring the Two Dimensions of the Stress from Uncertainty Scale
Full size table
Table 5 Original French and English Translation of Items Measuring Physician Job Satisfaction
Full size table

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-007-0159-7

KEY WORDS

  • uncertainty
  • quality of care
  • medical training
  • work-related satisfaction