Language, Literacy, and Sociocultural Studies ETDs

Publication Date

7-15-1997

Abstract

The reality of medicine and medical education is that uncertainty is ubiquitous, ambiguity confronts the physician at many points, and decisions are made in the face of incomplete information. Uncertainty is basic to medical care, especially primary care. However, it is seldom acknowledged much less included as a formal part of a medical curriculum. Uncertainty in primary care medicine needs to be identified, characterized and understood.

One of the opportunities to identify and characterize uncertainty in primary care ambulatory medicine is in a thorough description of the ways in which primary care physicians in an academic health center learn and teach about it. In this study, two different but related approaches were used to develop this description. Multiple observations of primary care faculty in the clinical ambulatory care teaching clinic were combined with structured interviews with the same physicians related to their experiences with uncertainty in medicine, prototypical patients and uncertainty, and their approaches to teaching about uncertainty in medicine.

Faculty physicians in this ambulatory primary care setting define continuity of care as an important underlying construct for them in reducing or controlling uncertainty in patient care. Faculty physicians in this study supplement continuity of care with complimentary models for approaching uncertainty in medicine which fall into eight categories: considering what the learner is learning; not acting; sharing uncertainty with the patient; listening to patients, allowing them to develop their narrative story line, and incorporating the patients' cultural and health beliefs into their care; considering what the stage of the physician teacher is in learning/teaching uncertainty process; forthrightly addressing one's own agenda in patient care interactions; use of evidence-based medicine and predictive tests; and reframing uncertainty from asking about certainty to asking what treatment or management approach would make the patient better able to function. In addition, these primary care physicians describe three different stages of response to uncertainty in medicine, a finding which needs to undergo further research.

Document Type

Thesis

Language

English

Degree Name

Language, Literacy and Sociocultural Studies

Level of Degree

Doctoral

Department Name

Language, Literacy, and Sociocultural Studies

First Committee Member (Chair)

Ann Nihlen

Second Committee Member

Andrea F. Vierra

Third Committee Member

Jan Gamradt

Fourth Committee Member

Nina Wallerstein

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