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Managing diagnostic uncertainty in primary care: a systematic critical review
BACKGROUND: Diagnostic uncertainty is one of the largest contributory factors to the occurrence of diagnostic errors across most specialties in medicine and arguably uncertainty is greatest in primary care due to the undifferentiated symptoms primary care physicians are often presented with. Physici...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545872/ https://www.ncbi.nlm.nih.gov/pubmed/28784088 http://dx.doi.org/10.1186/s12875-017-0650-0 |
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author | Alam, Rahul Cheraghi-Sohi, Sudeh Panagioti, Maria Esmail, Aneez Campbell, Stephen Panagopoulou, Efharis |
author_facet | Alam, Rahul Cheraghi-Sohi, Sudeh Panagioti, Maria Esmail, Aneez Campbell, Stephen Panagopoulou, Efharis |
author_sort | Alam, Rahul |
collection | PubMed |
description | BACKGROUND: Diagnostic uncertainty is one of the largest contributory factors to the occurrence of diagnostic errors across most specialties in medicine and arguably uncertainty is greatest in primary care due to the undifferentiated symptoms primary care physicians are often presented with. Physicians can respond to diagnostic uncertainty in various ways through the interplay of a series of cognitive, emotional and ethical reactions. The consequences of such uncertainty however can impact negatively upon the primary care practitioner, their patients and the wider healthcare system. Understanding the nature of the existing empirical literature in relation to managing diagnostic uncertainty in primary medical care is a logical and necessary first step in order to understand what solutions are already available and/or to aid the development of any training or feedback aimed at better managing this uncertainty. This review is the first to characterize the existing empirical literature on managing diagnostic uncertainty in primary care. METHODS: Sixteen databases were systematically searched from inception to present with no restrictions. Hand searches of relevant websites and reference lists of included studies were also conducted. Two authors conducted abstract/article screening and data extraction. PRISMA guidelines were adhered to. RESULTS: Ten studies met the inclusion criteria. A narrative and conceptual synthesis was undertaken under the premises of critical reviews. Results suggest that studies have focused on internal factors (traits, skills and strategies) associated with managing diagnostic uncertainty with only one external intervention identified. Cognitive factors ranged from the influences of epistemological viewpoints to practical approaches such as greater knowledge of the patient, utilizing resources to hand and using appropriate safety netting techniques. Emotional aspects of uncertainty management included clinicians embracing uncertainty and working with provisional diagnoses. Ethical aspects of uncertainty management centered on communicating diagnostic uncertainties with patients. Personality traits and characteristics influenced each of the three domains. CONCLUSIONS: There is little empirical evidence on how uncertainty is managed in general practice. However we highlight how the extant literature can be conceptualised into cognitive, emotional and ethical aspects of uncertainty which may help clinicians be more aware of their own biases as well as provide a platform for future research. TRIAL REGISTRATION: PROSPERO registration: CRD42015027555 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12875-017-0650-0) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5545872 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-55458722017-08-09 Managing diagnostic uncertainty in primary care: a systematic critical review Alam, Rahul Cheraghi-Sohi, Sudeh Panagioti, Maria Esmail, Aneez Campbell, Stephen Panagopoulou, Efharis BMC Fam Pract Research Article BACKGROUND: Diagnostic uncertainty is one of the largest contributory factors to the occurrence of diagnostic errors across most specialties in medicine and arguably uncertainty is greatest in primary care due to the undifferentiated symptoms primary care physicians are often presented with. Physicians can respond to diagnostic uncertainty in various ways through the interplay of a series of cognitive, emotional and ethical reactions. The consequences of such uncertainty however can impact negatively upon the primary care practitioner, their patients and the wider healthcare system. Understanding the nature of the existing empirical literature in relation to managing diagnostic uncertainty in primary medical care is a logical and necessary first step in order to understand what solutions are already available and/or to aid the development of any training or feedback aimed at better managing this uncertainty. This review is the first to characterize the existing empirical literature on managing diagnostic uncertainty in primary care. METHODS: Sixteen databases were systematically searched from inception to present with no restrictions. Hand searches of relevant websites and reference lists of included studies were also conducted. Two authors conducted abstract/article screening and data extraction. PRISMA guidelines were adhered to. RESULTS: Ten studies met the inclusion criteria. A narrative and conceptual synthesis was undertaken under the premises of critical reviews. Results suggest that studies have focused on internal factors (traits, skills and strategies) associated with managing diagnostic uncertainty with only one external intervention identified. Cognitive factors ranged from the influences of epistemological viewpoints to practical approaches such as greater knowledge of the patient, utilizing resources to hand and using appropriate safety netting techniques. Emotional aspects of uncertainty management included clinicians embracing uncertainty and working with provisional diagnoses. Ethical aspects of uncertainty management centered on communicating diagnostic uncertainties with patients. Personality traits and characteristics influenced each of the three domains. CONCLUSIONS: There is little empirical evidence on how uncertainty is managed in general practice. However we highlight how the extant literature can be conceptualised into cognitive, emotional and ethical aspects of uncertainty which may help clinicians be more aware of their own biases as well as provide a platform for future research. TRIAL REGISTRATION: PROSPERO registration: CRD42015027555 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12875-017-0650-0) contains supplementary material, which is available to authorized users. BioMed Central 2017-08-07 /pmc/articles/PMC5545872/ /pubmed/28784088 http://dx.doi.org/10.1186/s12875-017-0650-0 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Alam, Rahul Cheraghi-Sohi, Sudeh Panagioti, Maria Esmail, Aneez Campbell, Stephen Panagopoulou, Efharis Managing diagnostic uncertainty in primary care: a systematic critical review |
title | Managing diagnostic uncertainty in primary care: a systematic critical review |
title_full | Managing diagnostic uncertainty in primary care: a systematic critical review |
title_fullStr | Managing diagnostic uncertainty in primary care: a systematic critical review |
title_full_unstemmed | Managing diagnostic uncertainty in primary care: a systematic critical review |
title_short | Managing diagnostic uncertainty in primary care: a systematic critical review |
title_sort | managing diagnostic uncertainty in primary care: a systematic critical review |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545872/ https://www.ncbi.nlm.nih.gov/pubmed/28784088 http://dx.doi.org/10.1186/s12875-017-0650-0 |
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