““Deal or no deal”Deal or no deal”……UncertaintyUncertainty

Hannah, Daniela, Gill

Deal or no deal…Deal or no deal…

Would you have a logical order?Does this reflect how you deal with

uncertainty in your daily life?Are you a risk-taker?How do you deal with uncertainty in

consultations?

Uncertainty ?Uncertainty ?

During our years at medical school, we were trained in detecting and treating diseases rather than dealing with uncertainty.

The result? We order lab and radiological tests to excess despite relatively high probabilities of normal results or, coincidentally finding abnormalities that do not relate to the presenting complaints

Uncertain general Uncertain general practitioners…practitioners…

Part of daily lifeWhy… Too much knowledge and scientific evidence to

remember It is ever changing (fast!) Visited by patients in early and undifferentiated

stages of diseases Complaints that reflect combinations of organic

and psychosomatic origins

Role PlaysRole Plays

Split into 3 groups

20 mins

Flip chart

Why is there uncertainty in Why is there uncertainty in medicine?medicine?

In an ideal world:

Condition A + Treatment B = Outcome C

 BUT there is uncertainty at all stages of

this equation – why?

 

A: The diagnosisA: The diagnosis

Symptoms do not always present together in a textbook way Patients present in different ways at different stages of any one

disease Reporting of symptoms is biased depending on how patients

report them Patients may hold back symptoms they feel are “worrying” or

overemphasize them Doctor error in diagnosis due to insufficient or misleading

information Inconclusive test results Ease/availability of different tests Patient refusal of tests

B: Which treatment?B: Which treatment?

Evidence base Experimental treatments Patient preference Preconceived ideas or experiences regarding

treatments Alternative therapies Postcode prescribing Private vs. NHS treatment

C: The outcomeC: The outcome

Variability in disease response to treatment Patient understanding of treatment plan Patient compliance Variable support networks to help patients

through difficult treatments Differing expectations and perceptions of

success Presence of other, occult, disease which

interacts with A or B to alter predicted C

PLUS, impacting on each stage of the above is the actual relationship between the doctor and patient and the variability in doctors personality types

Can you think of personality traits in yourselves as doctors, that affect how you deal with uncertainty???

Doctors…Doctors…

Highly self-motivated Over working Driven Obsessive Determined Self critical PerfectionistThe above traits tend to make us more anxious

about the inevitable uncertainty that we face when dealing with patients

Uncertain phrases/ actionsUncertain phrases/ actions

What do you use?

“I haven’t come across this before”

“I don’t know”

Asking a nurse for advice

“Lets see what happens”

“I’m not sure about this”

Used a book to find out about a condition

Asked another GP for advice

“I think this might be…”

“I need time to find out more”

Used a computer to find out more information

• “I haven’t come across this before”

• “I don’t know”

• Asking a nurse for advice • “Lets see what happens” • “I’m not sure about this”

• Used a book to find out about a condition • Asked another GP for advice • “I think this might be…”

• “I need time to find out more”

• Used a computer to find out more info

• “I haven’t come across this before” 5

• “I don’t know” 2• Asking a nurse for advice 3

• “Lets see what happens” 1

• “I’m not sure about this” 6

• Used a book to find out about a condition 8

• Asked another GP for advice 10

• “I think this might be…” 4

• “I need time to find out more” 7

• Used a computer to find out more info 9

Coping with uncertaintyCoping with uncertainty

How do you cope?

No right or wrong answers!

1) TRUST1) TRUST

Patient in doctor – to keep up to date with knowledge, to seek help when needed, to listen to their needs and advise accordingly

 Doctor in patient – to tell them all the

relevant info, to adhere to agreed treatment plans

2) HONESTY2) HONESTY

Freedom to be open about the limitations of ones knowledge/skills

Acknowledgement of uncertainty to patients

Willingness to research things we’re not clear about and call patients back once better informed

3) AWARENESS3) AWARENESS

Of the presence of uncertainty, both to ourselves and to patients

Of the complexity of the uncertainty surrounding management of patients

Of our own personality types and approaches to risks/ uncertainty

Of what is important to our patients – their agenda and how much uncertainty they are willing to accept

Of our own limitations That failure to some degree is inevitable – “Ever tried.

Ever failed. No matter. Try again. Fail again. Fail better”

4) KINDNESS4) KINDNESS

If we treat people with compassion and kindness we will better understand their uncertainties and thereby be more able to manage them and accept them

So…Deal or no deal?!So…Deal or no deal?!

Lets play

SummarySummary

An awareness of the variety of sources of uncertainty

The different types of uncertainty faced from the point of view of both patient and the Dr

The impact of our personality types as doctors on management of uncertainty

How we might manage uncertainty in clinical practice and on a personal level

“In this world, nothing can be said to be certain, except death and taxes”

(Benjamin Franklin)

Thank-you!

Video…Finals fantasy by the Amateur Transplants!

http://www.youtube.com/watch?v=EdmiOhpqlLI