Managing diagnostic uncertainty in primary care: A systematic critical review

Rahul Alam, Sudeh Cheraghi-Sohi, Maria Panagioti, Aneez Esmail, Stephen Campbell, Efharis Panagopoulou

    Research output: Contribution to journalArticle

    21 Citations (Scopus)

    Abstract

    Background: Diagnostic uncertainty is one of the largest contributory factors to the occurrence of diagnostic errors across most specialties in medicine and arguably uncertainty is greatest in primary care due to the undifferentiated symptoms primary care physicians are often presented with. Physicians can respond to diagnostic uncertainty in various ways through the interplay of a series of cognitive, emotional and ethical reactions. The consequences of such uncertainty however can impact negatively upon the primary care practitioner, their patients and the wider healthcare system. Understanding the nature of the existing empirical literature in relation to managing diagnostic uncertainty in primary medical care is a logical and necessary first step in order to understand what solutions are already available and/or to aid the development of any training or feedback aimed at better managing this uncertainty. This review is the first to characterize the existing empirical literature on managing diagnostic uncertainty in primary care. Methods: Sixteen databases were systematically searched from inception to present with no restrictions. Hand searches of relevant websites and reference lists of included studies were also conducted. Two authors conducted abstract/article screening and data extraction. PRISMA guidelines were adhered to. Results: Ten studies met the inclusion criteria. A narrative and conceptual synthesis was undertaken under the premises of critical reviews. Results suggest that studies have focused on internal factors (traits, skills and strategies) associated with managing diagnostic uncertainty with only one external intervention identified. Cognitive factors ranged from the influences of epistemological viewpoints to practical approaches such as greater knowledge of the patient, utilizing resources to hand and using appropriate safety netting techniques. Emotional aspects of uncertainty management included clinicians embracing uncertainty and working with provisional diagnoses. Ethical aspects of uncertainty management centered on communicating diagnostic uncertainties with patients. Personality traits and characteristics influenced each of the three domains. Conclusions: There is little empirical evidence on how uncertainty is managed in general practice. However we highlight how the extant literature can be conceptualised into cognitive, emotional and ethical aspects of uncertainty which may help clinicians be more aware of their own biases as well as provide a platform for future research. Trial registration: PROSPERO registration: CRD42015027555

    Original languageEnglish
    Article number79
    Pages (from-to)1-13
    Number of pages13
    JournalBMC Family Practice
    Volume18
    Issue number1
    DOIs
    Publication statusPublished - 7 Aug 2017

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    Uncertainty
    Primary Health Care
    Primary Care Physicians
    Diagnostic Errors
    General Practice
    Personality
    Hand
    Medicine
    Databases
    Guidelines
    Delivery of Health Care
    Physicians
    Safety

    Cite this

    Alam, R., Cheraghi-Sohi, S., Panagioti, M., Esmail, A., Campbell, S., & Panagopoulou, E. (2017). Managing diagnostic uncertainty in primary care: A systematic critical review. BMC Family Practice, 18(1), 1-13. [79]. https://doi.org/10.1186/s12875-017-0650-0
    Alam, Rahul ; Cheraghi-Sohi, Sudeh ; Panagioti, Maria ; Esmail, Aneez ; Campbell, Stephen ; Panagopoulou, Efharis. / Managing diagnostic uncertainty in primary care: A systematic critical review. In: BMC Family Practice. 2017 ; Vol. 18, No. 1. pp. 1-13.
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    abstract = "Background: Diagnostic uncertainty is one of the largest contributory factors to the occurrence of diagnostic errors across most specialties in medicine and arguably uncertainty is greatest in primary care due to the undifferentiated symptoms primary care physicians are often presented with. Physicians can respond to diagnostic uncertainty in various ways through the interplay of a series of cognitive, emotional and ethical reactions. The consequences of such uncertainty however can impact negatively upon the primary care practitioner, their patients and the wider healthcare system. Understanding the nature of the existing empirical literature in relation to managing diagnostic uncertainty in primary medical care is a logical and necessary first step in order to understand what solutions are already available and/or to aid the development of any training or feedback aimed at better managing this uncertainty. This review is the first to characterize the existing empirical literature on managing diagnostic uncertainty in primary care. Methods: Sixteen databases were systematically searched from inception to present with no restrictions. Hand searches of relevant websites and reference lists of included studies were also conducted. Two authors conducted abstract/article screening and data extraction. PRISMA guidelines were adhered to. Results: Ten studies met the inclusion criteria. A narrative and conceptual synthesis was undertaken under the premises of critical reviews. Results suggest that studies have focused on internal factors (traits, skills and strategies) associated with managing diagnostic uncertainty with only one external intervention identified. Cognitive factors ranged from the influences of epistemological viewpoints to practical approaches such as greater knowledge of the patient, utilizing resources to hand and using appropriate safety netting techniques. Emotional aspects of uncertainty management included clinicians embracing uncertainty and working with provisional diagnoses. Ethical aspects of uncertainty management centered on communicating diagnostic uncertainties with patients. Personality traits and characteristics influenced each of the three domains. Conclusions: There is little empirical evidence on how uncertainty is managed in general practice. However we highlight how the extant literature can be conceptualised into cognitive, emotional and ethical aspects of uncertainty which may help clinicians be more aware of their own biases as well as provide a platform for future research. Trial registration: PROSPERO registration: CRD42015027555",
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    Alam, R, Cheraghi-Sohi, S, Panagioti, M, Esmail, A, Campbell, S & Panagopoulou, E 2017, 'Managing diagnostic uncertainty in primary care: A systematic critical review', BMC Family Practice, vol. 18, no. 1, 79, pp. 1-13. https://doi.org/10.1186/s12875-017-0650-0

    Managing diagnostic uncertainty in primary care: A systematic critical review. / Alam, Rahul; Cheraghi-Sohi, Sudeh; Panagioti, Maria; Esmail, Aneez; Campbell, Stephen; Panagopoulou, Efharis.

    In: BMC Family Practice, Vol. 18, No. 1, 79, 07.08.2017, p. 1-13.

    Research output: Contribution to journalArticle

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    Alam R, Cheraghi-Sohi S, Panagioti M, Esmail A, Campbell S, Panagopoulou E. Managing diagnostic uncertainty in primary care: A systematic critical review. BMC Family Practice. 2017 Aug 7;18(1):1-13. 79. https://doi.org/10.1186/s12875-017-0650-0