Dealing with medical uncertainty: a physician's perspective

Uncertainty in diagnosis is frequently encountered in medical practice and causes stress in patients and physicians. Factors contributing to uncertainty include biological variability of patients, patient and physician bias, error in test interpretation, differing values and opinions of patients and physicians, and uncertainty surrounding decision-making. Physicians differ in their ability to tolerate uncertainty, and this varying tolerance has been linked with choice of specialty, increased test ordering, personal anxiety, increased cost of providing medical care, and decreased comfort with geriatric patients and patients with psychological problems. We review the current evidence for and effects of physician uncertainty in medical practice. Although uncertainty in practice cannot be completely eliminated, numerous strategies can be adopted to decrease uncertainty and enhance patients' trust. These include applying the best-available evidence-based information along with observance of core clinical practices, including meticulous history taking, excluding worrisome diagnoses, and involvement in shared decision-making.