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?

More on uncertainty