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

Exit mobile version