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

Emotional intelligence

  • “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?

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