Coping
with uncertainty“Uncertainty looms over all of medicine, and you must be able to cope with the pain and guilt that it brings”
Issues
- Uncertainty is inevitable in primary care (and medicine in general)
- Need to use relationships skilfully
- Equipoise – exploring individual risk-benefit equations
How we respond tuncertainty (how does uncertainty make us feel?)
- Our behaviour with the patient
- Our behaviour with others as a result of our uncertainty
- The novelty factor
Aggravating factors in uncertainty
- The doctor
- The impostor syndrome – the risk of being found out
- Personality – some personalities will find uncertainty more difficult
- The black hole – “I don’t know what I don’t know”
- Low self-esteem in the doctor
- The doctor’s need to help
- Doctors beliefs about societal obligations to protect the vulnerable
- The patient
- A dreaded outcome eg death, a complaint
- Insoluble problems
- An uncertain degree of risk in the decision-making process
- Somatisation
- Natural variations in the disease process
- Dependency by the patient on the medical model resulting in the patient expecting that the doctor always will know the answer
- The consultation
- A problem not recognised by pattern recognition
- Choices in management
- Doctor-centred consulting resulting in difficulty with sharing uncertainty with the patient and the ability to encourage or even receive feedback from the patient
- The doctor’s and the patient’s personal boundaries
- Medical decision making requires combinatorial analysis to comprehend patients' uniqueness and avoid harmful, unnecessary trial and error
- Society
- Socially mediated sense of threat eg mass media or lobby groups
Developing strategies
- For the doctor
- Information systems and decision support
- Emotional intelligence
- Exploring personal resistance to risk-taking
- Reality-checking – “what is really likely?”
- Narrative based medicine
- Developing the doctor’s personal self-awareness
- Building personal resilience – emotional support, healthy living
- Deconstructing the “pain and guilt”
- Sharing uncertainty – patient, colleagues
- Support – mentoring/co-mentoring
- In the consultation
- The disease-illness model
- Negotiation in decision-making – risk management
- Sharing responsibility for decision-making
- Ideas, concerns and expectations
- Patient-centred feelings-based communication
7 habits of highly effective people
- "Accept uncertainty as part of life because it is." What are some simple things they can do to accept uncertainty without inviting anxiety?
- How can you accurately assess the risk of physical or emotional danger?
- How can you "re-educate your brain" to stop obsessing about potential dangers?
- How can using affirmations help restore inner peace and what are some examples of them?
- Stress-reduction techniques
- How can you raise your "frustration tolerance" and how does the help you to cope with uncertainty?
- How could forgiveness help them cope with uncertainty and anxiety?
- Connecting with others to create meaning. Why and what are some ways to do this?
- Flexibility in the face of change yields immeasurable opportunities for positive growth and renewal. How so and what do you suggest for becoming more flexible?