The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia; The University of Sydney, Sydney School of Public Health, Menzies Centre for Health Policy and Economics, Sydney, New South Wales, Australia.
The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.
Soc Sci Med. 2022 Nov;313:115422. doi: 10.1016/j.socscimed.2022.115422. Epub 2022 Oct 3.
Despite clinicians being important actors in the context of uncertainty, their experiences navigating uncertainty remain largely unexplored. Drawing on a theory-driven post-qualitative approach, we used Mol's logic of choice/care as a lens through which we made sense of interviews with 22 clinicians who work with patients who experience low back pain (LBP). Our analysis suggests that uncertainty is ubiquitous in LBP care and not limited to particular domains. Clinicians navigated uncertainty when considering patients' personal and social contexts; making therapeutic decisions; navigating emotions and mental health; communicating with, and educating, patients, among others. These uncertainties are intertwined with clinical aspects such as treatment choices and evidence-based education about LBP. At times, clinicians resolved these uncertainties by producing certainty at the cost of attending to human aspects of care. We argue that epistemic shifts, theorisation and practical engagement with theory in training, research and clinical practice may prompt clinicians to embrace uncertainty and enact the logic of care.
尽管临床医生是不确定性背景下的重要参与者，但他们在应对不确定性方面的经验在很大程度上仍未得到探索。本研究采用一种理论驱动的后实证主义方法，以莫尔的选择/关怀逻辑为视角，对 22 名与腰痛患者合作的临床医生进行了访谈，理解他们的经验。我们的分析表明，不确定性在腰痛护理中普遍存在，而不限于特定领域。临床医生在考虑患者的个人和社会背景、做出治疗决策、应对情绪和心理健康、与患者沟通和教育等方面时，都会遇到不确定性。这些不确定性与治疗选择和关于腰痛的循证教育等临床方面相互交织。有时，临床医生会通过制造确定性来解决这些不确定性，但这是以忽视护理的人为方面为代价的。我们认为，认识论的转变、理论化以及在培训、研究和临床实践中对理论的实际参与，可能会促使临床医生接受不确定性并实施关怀逻辑。
