medigraphic.com
Órgano de Difusión de la Asociación Académica Panamericana de Medicina Familiar A.C.

2018, Number 2

<< Back Next >>

Arch Med Fam 2018; 20 (2)

Uncertainty and its Repercussions: How do Young Doctors Feel about the Uncertainty in Their Professional Practice?

Rozenfeld LM, Muller AB

Language: Portugués
References: 44
Page: 59-74
PDF size: 339.58 Kb.


ABSTRACT

Purpose: The aim of this study was to develop a characterization profile of the perceptions and attitudes of resident physicians in a general hospital in São Paulo, Brazil addressing the uncertainties related to the care – of patients. Methods: Descriptive, comparative and cross-sectional study conducted from April to July 2013 with a convenience sample of 90 medical residents who completed the Physicians´ Reactions to Uncertainty (PRU) scale and provided demographic variables of gender, age and specialty. Results: Comparing the Physician´s Reaction to Uncertainty score, authors identified a significant difference between age, year of residence and gender. Physicians who were female, less than 26 years old and who were in their first year of residency and had greater clinical uncertainty than men (p=0.002), older residents (p= 0,001), those in their second and third year of residency (p‹0,001). There were no significant differences by medical speciality (p=0,792). Conclusion: Practical experience and age are important factors in clinical uncertainty in residence groups. The longer physicians are in practice, the less uncertainty they will experience. Ways to decrease the anxiety of and reluctance to disclose uncertainty to patient can include: 1) Practice together with experience doctors; 2) Clinical epidemiology; 3) knowledge of philosophy and 4) Humanistic teaching.


REFERENCES

  1. Gerrity MS, Earp JAL, DeVellis RF, Light DW. Uncertainty and professional Work: Perceptions of physicians in clinical practice. American Journal of Sociology 1992; 97(4): 1022-51.

  2. Applegate, WB. Physician Managment of patients with adverse outcomes. Archives of Internal Medicine 1986; 146:2249-52

  3. Atkinson, P. Training for certainty. Social Science and medicine 1984; 19:949-56.

  4. Bosk, CL. Occupational Rituals in Patient Management. New England Journal of Medicine 1980; 303:71-76.

  5. Kassier, JP. Our stubborn quest for diagnostic certainty: A cause of excessive testing. New England Journal of Medicine1989; 320: 1489-91.

  6. Peterson DK, Pitz GF.. Confidence, uncertainty, adn the use of information. Journal of experimental psychology 1988;14:85-92.

  7. Fox Rc. Training for uncertainty. In: Merton R, Reader RC, Kendall P, eds; Tge students-physician: introductory studies in the sociology of medical education. Cambrindge, Ma: Harvard University Press, 1957:207.

  8. Fox Rc. The evolution of medical uncertainty. Milbank MQ 1980: 58:1.

  9. Bursztajjn H, Feinbloom Ri, Hamm RM, Brodsky A. Medical choices , medical chances: how patients, families, and physician can cope with uncertainty. New York, NY: Delacort, 1981.

  10. Gutheil TG, Bursztajjn H, Brodsky A. Malpractice prevention through the sharing of uncertainty. Informed consent and therapeutic alliance. New England Journal of Medicine 1984;311:49.

  11. Eddy DM, Billings J. The quality of medical evidence: implications for quality of care. Health Aff 1988;7:19.

  12. Katz J. Why doctors don´t disclosure uncertainty. Hasting Cent Rep. 1984: 14:35.

  13. Johson Cg, Levenkron JC, suchman AL, Manchester R. Does physician uncertainty affects patients satisfaction? Journal General Internal Medicine 1988;3:144.

  14. Eddy DM. Variations in physician practice: the role of uncertainty. Health Aff 1984;3(2):74-89

  15. Wennberg JE, Barnes BA, Zubkoff M. Professional uncertainty and the problem of supplier-induced demand. Soc. Sci Med 1982;16:811.

  16. Linn LS, Yager J, Leake BD, et al. Diference in the mumbers and costs of tests ordered by internist, family physicians and psychiatrists. Inquiry 1984;22:226.

  17. Lusted LB. Uncertainty and indecision. Med Descis Making 1985;4:397.

  18. Curley Sp, Young MJ, Yates JF. Caracterizing physician perceptions of ambiguity. Med Descis Making 1989;9:116.

  19. Hogarth RM. Judgement and choice: the psychology of decision. New York, NY: John Wiley and sons 1987:86.

  20. Hershey JC, Baron J. Clinical reasoning and cognitive processes. Med Descis Making 1987;7:203.

  21. Nightingale SD. Risk preference and laboratory test selection. J Gen Intern Med 1897;2: 25.

  22. Nightingale SD. Risk preference and admitting rates of emergency room physician. Med Care 1988; 26:84.

  23. Evans L, Trotter MA. Epistemology and uncertainty in primary care: na exploratoty study. Fam Med 2009;4195): 319-26.

  24. Lazarus RS. Stress and emotion: a new synthesis. New York: Springer, 1999.

  25. Beresford Eb. Uncertainty and the shaping of medical decisions. Hasting Cent Rep. 1991;21:6-11.

  26. Farnan JM, Johson JK, Meltzer DO, Humphrey HJ, Arora VM. Resident uncertainty in clinical question making and impact on patient care: a qualitative study. Qual Saf Health Care. 2008;17:122-216.

  27. Light D Jr. Uncertainty and control in professional training. J Health Soc Behav. 1979;20:310-2

  28. Lord RG, Kimoski RJ, Kanfer R, editors. Emotions in the workplace: understanding the structure and role of emotions in organizational behavior. San Francisco: Pfeiffer; 2002.

  29. Green Ml, Ruff TR. Why do residents fail to answer their clinical questions? A qualitative study of barriers to practicing evidence based medicine. Acad Med. 2005;80:176-82.

  30. Nevalainen MK, et al. Facing uncertainty as a medical student - a qualitative study of their reflective learning diaries and writings on specific themes during the first clinical year. Patient Educ Couns. 2009.

  31. Schneider A, Szecsenyi J, Barie S, Joest K, Rosemann validation and cultural adaptation of a German version of the physicians’ reactions to Uncertainty scales. BMC Health. 2007;Serv Res 7:81.

  32. Schneider A, Wubken M, Linde K, Buhner M. Communicating and dealing with uncertainty in general practice: the association with neuroticism. Plos One. 2014;9(7):1-7.

  33. Gerrity MS, White KP, DeVellis RF, Dittus RS. Physicians’ reactions to uncertainty: refining the constructs and scales. Motivation and Emotion 1995;19(3):175-91.

  34. Blasco PG, Roncoletta AFT, Moreto G,Levites MR, Janaudis MA. Accompanying physicians in their family practice: A primary care model for medical students’ learning in Brazil. Fam Med. 2006;38:619 –621.

  35. José. A Odisséia da Filosofia. São Paulo: Abril, 2015.

  36. Marañón G. La medicina y nuestro tiempo Espasa Calpe. Madrid.1954.

  37. Inneraty, D. “ Ética de la hospitalidad”. Peninsula . Bracelona 2001. Pág24-27.

  38. Ortega Y Gasset J. Notas de andar y ver. Revista de Occidente. Alianza Editorial. Madrid, 1988, pg. 21

  39. Newman, JH. Discursos sobre Le fin y La naturaleza de La Educación Universitária. Eunsa. Navarra. Espanha, 1996.

  40. Newman, J.H. The Idea of a University. Oxford: Oxford University Press, 1976.

  41. Platão. Protágoras in Diálogos. Tradução de Carlos Alberto Nunes. São Paulo: Ed. Melhoramentos. 1970, P. 227, 309c.

  42. Platão. As Leis . São Paulo: Edipro, 1999, p. 67

  43. Aristóteles. Ética a Nicómaco. Edipro. 2009.

  44. Ortega y Gasset, J. La Rebelión de las Masas. Editora Espasa. 1946.




2020     |     www.medigraphic.com