Varieties of Uncertainty in Health Care

Abstract

Uncertainty is a pervasive and important problem that has attracted increasing attention in health care, given the growing emphasis on evidence-based medicine, shared decision making, and patient-centered care. However, our understanding of this problem is limited, due in part to the absence of a unified, coherent concept of uncertainty. There are multiple meanings and varieties of uncertainty in health care, which are not often distinguished or acknowledged although each may have unique effects or warrant different courses of action. The literature on uncertainty in health care is thus fragmented, and existing insights have been incompletely translated to clinical practice. In this paper we attempt to address this problem by synthesizing diverse theoretical and empirical literature from the fields of communication, decision science, engineering, health services research, and psychology, and developing a new integrative conceptual taxonomy of uncertainty. We propose a three-dimensional taxonomy that characterizes uncertainty in health care according to its fundamental sources, issues, and locus. We show how this new taxonomy facilitates an organized approach to the problem of uncertainty in health care by clarifying its nature and prognosis, and suggesting appropriate strategies for its analysis and management.

“It´s incredible how much I´ve had to fight.” Negotiating medical uncertainty in clinical encounters

“…So far, there has been a lack of attention afforded to the power dimension of service delivery fused by medical uncertainty, and knowledge of how doctors and patients manage uncertainty is fragmented (Atkins, Brownell, Kornelsen, Woollard, & Whiteley, 2013; Han et al, 2011). Such knowledge is important because delivering health services to patients with illness fraught with uncertainty involves heightened potential for the misuse of power, especially on the part of the (usually) most influential actors: doctors (Freidson, 1970; Katz, 1984).…”

“…Medical uncertainty—understood as a state of doubt and ambiguity about the aetiology, diagnosis, treatment, and/or prognosis of illness—is an inherent quality of all biomedical knowledge and clinical practice, to various degrees (Han, Klein, & Arora, 2011). Somatic symptoms without discernible organic pathology, or so-called medically unexplained physical symptoms (MUPS), score high on all accounts.…”

Challenges of implementing sustainable health care delivery in Nigeria under environmental uncertainty

“…A new integrated conceptual taxonomy characterizes uncertainty in health care according to its fundamental sources, issues and locus. Han et al [6] developed an organizing conceptual framework that categorizes these varieties in a coherent, useful way to add value to clinicians, researchers and health policy makers. The three sources of uncertainty in health care are as follows:  Probability (indeterminacy of future outcome) -clinical uncertainty could arise from an individual clinician's limitations in medical knowledge or policy and/or in cognitive and affective functioning.…”

“… Complexity (multiplicity of causal factors and interpretive cues) [6] . Uncertainty could also be a problem resulting from living within complex adaptive systems where varying mixes of natural and man-made systems interact and resist control [5] .…”

“…Collaborative engagement with case-based uncertainty in small groups of clinicians, and other health professionals are faced with initial trial and error process of false starts and blind alleys during investigation of a disease condition. Over time and repeated effort, the investigating clinicians finally gain better understanding that inform their subsequent decisions on the disease management [6,7] .…”