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Strategies for managing uncertainty and complexity

M G Hewson1, P J Kindy, J Van Kirk

  • 1Department of Medicine, University of Wisconsin, Madison, USA.

Journal of General Internal Medicine
|August 1, 1996
PubMed
Summary
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Primary care physicians use nine key strategies to manage complex and uncertain patient problems, improving diagnosis and treatment. These strategies, part of "strategic medical management," are crucial for effective clinical decision-making.

Area of Science:

  • Medical Education
  • Clinical Decision Making
  • Primary Care Medicine

Background:

  • Primary care settings frequently encounter patients with complex and uncertain medical problems.
  • Effective management of these cases requires specific physician strategies beyond standard diagnostic protocols.

Purpose of the Study:

  • To identify and describe physician strategies used in diagnosing and treating complex primary care issues.
  • To evaluate the perceived importance and incidence of these strategies in clinical practice.

Main Methods:

  • Observational study of physicians interacting with standardized patients presenting complex cases.
  • Analysis of recorded physician-patient encounters to identify behavioral patterns (strategies).
  • Questionnaire-based assessment of strategy importance by faculty physicians and incidence across various cases and experience levels.

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Main Results:

  • Nine distinct physician strategies were identified and deemed important for primary care.
  • These strategies encompass defining diagnostic context, managing patient beliefs, negotiating treatment plans, and maintaining diagnostic flexibility.
  • The identified strategies were consistently applied across different clinical cases and physician experience levels.

Conclusions:

  • The nine strategies form the basis of "strategic medical management" for uncertain and complex primary care problems.
  • This construct offers a framework integrating clinical decision-making and doctor-patient communication.
  • Strategic medical management relies on tacit knowledge with implications for medical education and assessment.