Abstract
BackgroundUncertainty 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.MethodsAn interview study was conducted among a strategic sample of 25 general practitioners (GPs).ResultsAll 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.ConclusionThe 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0452-9) contains supplementary material, which is available to authorized users.
Highlights
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
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 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 (Table 1)
Summary
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. Recent years’ achievements in research concerning infections have resulted in expanded evidence relevant for the primary care population and evidence-based guidelines are published in many Western countries for common infections in primary care. As another suggested tool to decrease uncertainty and increase appropriate antibiotic prescribing, near-patient tests have been introduced in primary care in several Western countries [8]. Important means to reduce uncertainty are used for common infections in primary care
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