Does physician uncertainty affect patient satisfaction?

Abstract

Physicians may choose one of several strategies when initially uncertain about making a specific therapeutic recommendation. The authors investigated how patients' satisfaction is affected by disclosure of uncertainty and its attempted resolution during a clinical encounter. Three hundred and four patients awaiting appointments at a university hospital's ambulatory medical clinic were randomized to view one of five videotapes (VTs) of a patient seeking advice about antimicrobial prophylaxis for a heart murmur. In VT-1 and VT-2, the physician disclosed no uncertainty and prescribed therapy. In VT-3, VT-4, and VT-5, the physician openly conveyed uncertainty but then: (VT-3) prescribed antibiotics without resolving his uncertainty; (VT-4) consulted a reference book with the patient present, then prescribed; or (VT-5) checked a computer with the patient present, then prescribed. Patients rated their satisfaction with the physician on a standardized questionnaire. Differences in satisfaction between the five VTs were significant (p = 0.001), with the highest ratings found for VT-1 and VT-2, where no uncertainty was disclosed. The lowest ratings in satisfaction were found when the physician expressed but then ignored uncertainty (VT-3) or examined a textbook (VT-4). Global satisfaction was inversely and significantly correlated (r = -0.47) with the patients' perception of uncertainty in the physician. The manner in which clinical uncertainty is disclosed to patients and then resolved by the physician appears to affect patients' satisfaction.

Communicating the Uncertainty of Harms and Benefits of Medical Interventions

“…Physicians are often concerned that acknowledging uncertainty to patients may undermine patient trust and satisfaction. However, some research has shown that patient satisfaction is affected by the manner in which the physician handles uncertainty, not whether or not he or she presents uncertainty, 99 consistent with previous theories. 100 When physicians are comfortable with uncertainty and collaborate with their patients in their medical care, patient trust and satisfaction are actually high.…”

Provider Recommendations in the Face of Scientific Uncertainty: An Analysis of Audio-Recorded Discussions about Vitamin D

“…28 Active participation would involve discussions of uncertainty and alternatives. Some existing studies suggest that when providers express uncertainty during medical encounters, patients are less satisfied and confident in their provider, [29][30][31] but these studies mostly examined scenarios in which providers indicated that they were unsure about proper treatments. Patient reactions to discussions of medical uncertainty require additional investigation.…”

“Could this Be Something Serious?”

“…Although uncommon, physicians' expressions of uncertainty ("I don't know...") were not associated with lower patient ratings of the physician, in contrast to survey and vignette studies which suggest otherwise. 51,52 Concern has been raised about the inappropriate use of reassurance without adequate biomedical explanations or lack of empathic responses when patients present with MUS. 5,6 However, even accounting for the increased number of prompts in the MUS role, we found that physicians used empathy at least as frequently in the MUS role compared with the more straightforward GERD presentation, did not attempt to reassure more often, explored psychosocial domains, and admitted uncertainty more often.…”