Myklestul Hans-Christian, Skjeie Holgeir, Brekke Mette, Skonnord Trygve
Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
Scand J Prim Health Care. 2025 Mar;43(1):219-229. doi: 10.1080/02813432.2024.2423242. Epub 2024 Nov 6.
Point-of-care ultrasound (POCUS) has long been a diagnostic tool in family medicine, although most Norwegian general practitioners (GPs) who use POCUS, scans infrequently. The broad scope of family medicine, the relatively low prevalence of illnesses and infrequent use of POCUS imply that GPs may experience diagnostic uncertainty regularly.
To explore how GPs perceived and managed diagnostic uncertainty when using POCUS.
A qualitative focus group study among Norwegian GPs using POCUS.
Four focus group discussions were conducted. Total number of participants were 21. The interview guide was piloted, the focus group discussions were audio-recorded and transcribed, and Systematic Text Condensation, a thematic cross-case analysis, was used to analyse the data.
Diagnostic uncertainty using POCUS was considered as aligning to the general clinical uncertainties in family medicine, but there were also POCUS-specific uncertainties in clinical decision-making. We generated six themes: emotional, cognitive, and ethical uncertainty using POCUS, communicating uncertainty to patients, interaction with specialists when using POCUS, and coping strategies of participants. POCUS results were the only results the participants sometimes withheld when communicating with other specialists. POCUS itself stimulated a renewed interest in family medicine. Scanning enough patients was the recommended coping strategy.
POCUS-using GPs experienced diagnostic uncertainty when using POCUS that aligned with other diagnostic uncertainties they experienced in everyday practice. However, they did not treat the results like other findings, as the GPs at times withheld their POCUS findings when interacting with secondary care specialists. This requires further investigation.
即时超声检查（POCUS）长期以来一直是家庭医学中的一种诊断工具，尽管大多数使用POCUS的挪威全科医生（GP）很少进行扫描。家庭医学的广泛范围、疾病相对较低的患病率以及POCUS的不频繁使用意味着全科医生可能经常经历诊断不确定性。
探讨全科医生在使用POCUS时如何感知和处理诊断不确定性。
对使用POCUS的挪威全科医生进行定性焦点小组研究。
进行了四次焦点小组讨论。参与者总数为21人。访谈指南经过了预试验，焦点小组讨论进行了录音和转录，并使用系统文本浓缩法（一种主题跨案例分析方法）对数据进行了分析。
使用POCUS时的诊断不确定性被认为与家庭医学中的一般临床不确定性相符，但在临床决策中也存在POCUS特有的不确定性。我们生成了六个主题：使用POCUS时的情感、认知和伦理不确定性、向患者传达不确定性、使用POCUS时与专科医生的互动以及参与者的应对策略。POCUS结果是参与者在与其他专科医生交流时有时会隐瞒的唯一结果。POCUS本身激发了对家庭医学的新兴趣。扫描足够数量的患者是推荐的应对策略。
使用POCUS的全科医生在使用POCUS时经历了诊断不确定性，这与他们在日常实践中遇到的其他诊断不确定性相符。然而，他们对这些结果的处理方式与其他检查结果不同，因为全科医生在与二级医疗专科医生互动时有时会隐瞒他们的POCUS检查结果。这需要进一步调查。
