Management 1: Coping with uncertainty
|The doctor, having failed to make a firm diagnosis shows intolerance of uncertainty by a hurried rush to treatment investigation or referral, without thought for the patient’s convenience, or proper concern for NHS economy.
||The doctor, having excluded immediate risks is prepared to ‘use time as a tool’ to allow things to become clear, while giving the patient support and gaining his/her trust; when this is not possible he or she uses diagnostic and referral facilities appropriately, economically and with due regard to the patient’s feelings.
|Has little understanding of this.
||Attempts to do this but is not yet skilful and sometimes runs into difficulty.
||Attempts to do this and is usually successful but recognises his/her limitations.
||Once he or she is sure that the patient is not endangered, is prepared to wait and watch.
||If he or she has decided on ‘masterly inactivity’ sets out to gain the patient’s trust for the course of action.
||Where necessary chooses investigations which take into account both the feelings and convenience of the patient and also health service costs.
||Where necessary gets consultant help in the most cost effective and considerate way.*
Notes for raters
This area of behaviour is best assessed by case discussion, asking, “Whydid you do that?”, “Had you thought whether. ..?”, “Couldn’tit have waited?”
*See Appendix C for expanded scale to cover referral.