Bovier Patrick A, Perneger Thomas V
Department of Community Medicine, Medical Outpatient Clinic, University Hospitals of Geneva, Geneva, Switzerland.
J Gen Intern Med. 2007 May;22(5):632-8. doi: 10.1007/s11606-007-0159-7. Epub 2007 Mar 9.
Uncertainty shapes many decisions made by physicians everyday. Uncertainty and physicians' inability to handle it may result in substandard care and unexplained variations in patterns of care.
To describe socio-demographic and professional characteristics of reactions to uncertainty among physicians from all specialties, including physicians in training.
Cross-sectional postal survey.
All physicians practicing in Geneva, Switzerland (n = 1,994).
Reaction to medical care uncertainty was measured with the Anxiety Due to Uncertainty and Concern About Bad Outcomes scales. The questionnaire also included items about professional characteristics and work-related satisfaction scales.
After the first mailing and two reminders, 1,184 physicians responded to the survey. In univariate analysis, women, junior physicians, surgical specialists, generalist physicians, and physicians with lower workloads had higher scores in both scales. In multivariate models, sex, medical specialty, and workload remained significantly associated with both scales, whereas clinical experience remained associated only with concern about bad outcomes. Higher levels of anxiety due to uncertainty were associated with lower scores of work-related satisfaction, while higher levels of concern about bad outcomes were associated with lower satisfaction scores for patient care, personal rewards, professional relations, and general satisfaction, but not for work-related burden or satisfaction with income-prestige. The negative effect of anxiety due to uncertainty on work-related satisfaction was more important for physicians in training.
Physicians' reactions to uncertainty in medical care were associated with several dimensions of work-related satisfaction. Physicians in training experienced the greatest impact of anxiety due to uncertainty on their work-related satisfaction. Incorporating strategies to deal with uncertainty into residency training may be useful.
不确定性影响着医生日常做出的许多决策。不确定性以及医生应对它的能力不足可能导致医疗服务质量不达标以及医疗模式中出现无法解释的差异。
描述所有专业的医生，包括实习医生，对不确定性反应的社会人口学和专业特征。
横断面邮寄调查。
在瑞士日内瓦执业的所有医生（n = 1994）。
使用不确定性焦虑量表和对不良后果的担忧量表来测量对医疗不确定性的反应。问卷还包括有关专业特征和工作相关满意度量表的项目。
在首次邮寄问卷并进行两次提醒后，1184名医生回复了调查。在单因素分析中，女性、初级医生、外科专科医生、全科医生以及工作量较低的医生在两个量表上得分更高。在多变量模型中，性别、医学专业和工作量与两个量表仍显著相关，而临床经验仅与对不良后果的担忧相关。因不确定性导致的较高焦虑水平与工作相关满意度得分较低相关，而对不良后果的较高担忧水平与患者护理、个人回报、职业关系和总体满意度的较低满意度得分相关，但与工作相关负担或对收入声望的满意度无关。因不确定性导致的焦虑对工作相关满意度的负面影响在实习医生中更为明显。
医生对医疗不确定性的反应与工作相关满意度的几个维度相关。实习医生因不确定性导致的焦虑对其工作相关满意度的影响最大。将应对不确定性的策略纳入住院医师培训可能会有所帮助。
