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Uncertainty in clinical practice - an interview study with Swedish GPs on patients with sore throat
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Linkoping Univ, Dept Med & Hlth Sci, Family Med, Linkoping, Sweden.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
Lund Univ, Dept Clin Sci, Family Med, Malmo, Sweden.;Blekinge Cty Council, Blekinge Ctr Competence, Karlskrona, Sweden..
Lund Univ, Dept Clin Sci, Family Med, Malmo, Sweden.;Skane Reg, Ctr Primary Hlth Care Res, Malmo, Sweden..
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2016 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 17, 56Article in journal (Refereed) PublishedText
Abstract [en]

Background: Uncertainty is inevitable in clinical practice in primary care and tolerance for uncertainty and concern for bad outcomes has been shown to vary between physicians. Uncertainty is a factor for inappropriate antibiotic prescribing. Evidence-based guidelines as well as near-patient tests are suggested tools to decrease uncertainty in the management of patients with respiratory tract infections. The aim of this paper was to describe strategies for coping with uncertainty in patients with pharyngotonsillitis in relation to guidelines.

Methods: An interview study was conducted among a strategic sample of 25 general practitioners (GPs).

Results: All GPs mentioned potential dangerous differential diagnoses and complications. Four strategies for coping with uncertainty were identified, one of which was compliant with guidelines, "Adherence to guidelines", and three were idiosyncratic: "Clinical picture and C-reactive protein (CRP)", "Expanded control", and "Unstructured". The residual uncertainty differed for the different strategies: in the strategy "Adherence to guidelines" and " Clinical picture and CRP" uncertainty was avoided, based either on adherence to guidelines or on the clinical picture and near-patient CRP; in the strategy " Expanded control" uncertainty was balanced based on expanded control; and in the strategy "Unstructured" uncertainty prevailed in spite of redundant examination and anamnesis.

Conclusion: The majority of the GPs avoided uncertainty and deemed they had no problems. Their strategies either adhered to guidelines or comprised excessive use of tests. Thus use of guidelines as well as use of more near-patient tests seemed associated to reduced uncertainty, although the later strategy at the expense of compliance to guidelines. A few GPs did not manage to cope with uncertainty or had to put in excessive work to control uncertainty.

Place, publisher, year, edition, pages
2016. Vol. 17, 56
Keyword [en]
Uncertainty, General practitioners, Sore throat, Guideline, C-reactive protein, Qualitative research
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-298088DOI: 10.1186/s12875-016-0452-9ISI: 000375989200001PubMedID: 27188438OAI: diva2:944562
Available from: 2016-06-29 Created: 2016-06-29 Last updated: 2016-06-29Bibliographically approved

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Andre, MalinGröndal, Hedvig
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