Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
School of Health Sciences, The University of Surrey, Surrey, UK.
BMC Prim Care. 2024 Aug 12;25(1):296. doi: 10.1186/s12875-024-02526-x.
Managing diagnostic uncertainty is a major challenge in primary care due to factors such as the absence of definitive tests, variable symptom presentations and disease evolution. Maintaining patient trust during a period of investigative uncertainty, whilst minimising scope for diagnostic error is a challenge. Mismanagement can lead to diagnostic errors, treatment delays, and suboptimal patient outcomes.
Our aim was to explore how UK primary care physicians (GPs) address and communicate diagnostic uncertainty in practice.
This qualitative study used video and audio-recordings. Verbatim transcripts were coded with a modified, validated tool to capture GPs' actions and communication in primary care consultations that included diagnostic uncertainty. The tool includes items relating to advice regarding new symptoms or symptom deterioration (sometimes called 'safety netting'). Video data was analysed to identify GP and patient body postures during and after the delivery of the management plan.
All patient participants had a consultation with a GP, were over the age of 50 and had (1) at least one new presenting problem or (2) one persistent problem that was undiagnosed.
Data collection occurred in GP-patient consultations during 2017-2018 across 7 practices in UK during 2017-2018.
GPs used various management strategies to address diagnostic uncertainty, including (1) symptom monitoring without treatment, (2) prescribed treatment with symptom monitoring, and (3) addressing risks that could arise from administrative tasks. GPs did not make management plans for potential treatment side effects. Specificity of uncertainty management plans varied among GPs, with only some offering detailed actions and timescales. The transfer of responsibility for the management plan to patients was usually delivered rather than negotiated, with most patients confirming acceptance before concluding the discussion.
We offer guidance to healthcare professionals, improving awareness of using and communicating management plans for diagnostic uncertainty.
由于缺乏明确的诊断测试、症状表现和疾病演变的多变性等因素，管理诊断不确定性是初级保健中的一个主要挑战。在调查不确定性期间保持患者信任，同时最大限度地减少诊断错误的范围是一项挑战。管理不善可能导致诊断错误、治疗延误和患者结局不佳。
我们旨在探讨英国初级保健医生（全科医生）如何在实践中解决和沟通诊断不确定性。
这项定性研究使用了视频和音频记录。逐字记录使用经过修改和验证的工具进行编码，以捕捉初级保健咨询中包括诊断不确定性在内的全科医生的行动和沟通。该工具包括与新症状或症状恶化（有时称为“安全网”）有关的建议。视频数据用于分析在管理计划实施期间和之后，医生和患者的身体姿势。
所有参与患者都与全科医生进行了咨询，年龄在 50 岁以上，且（1）至少有一个新的就诊问题或（2）有一个未确诊的持续存在的问题。
数据收集发生在 2017 年至 2018 年期间，在英国的 7 家实践中，对全科医生-患者咨询进行了 2017 年至 2018 年的咨询。
全科医生使用了各种管理策略来处理诊断不确定性，包括（1）无治疗的症状监测，（2）有症状监测的规定治疗，以及（3）解决可能因行政任务而产生的风险。全科医生没有为潜在治疗副作用制定管理计划。不确定性管理计划的具体性因全科医生而异，只有一些医生提供详细的行动和时间表。管理计划责任向患者的转移通常是交付而不是协商的，大多数患者在结束讨论前确认接受。
我们为医疗保健专业人员提供指导，提高他们对使用和沟通诊断不确定性管理计划的认识。
