Uncertainty of Physicians and Patients in Medical Decision Making

Abstract

Modern medicine has developed an apparently unlimited array of diagnostic and therapeutic tools; for example, treatment options for patients with hematologic malignancies are expanding rapidly. These developments, offering a spectrum of modalities, provide a new outlook on successful treatment for many patients. Nontheless, decisions regarding the optimum treatment strategy for any individual patient remain challenging, given that all prognostic projections are based on statistics. The challenge lies in identifying parameters that characterize individual patients as prospective responders or nonresponders and thus determine the prognosis. Both physicians and patients are confronted with the uncertainty of the success of treatment with any strategy in a particular disease condition and with the impact of treatment on overall prognosis. How certain can a physician be that an individual patient has the best prognosis with a particular intervention? How does a physician's own uncertainty affect decisions made by a less-informed patient? Here we examine various aspects of uncertainty and their relevance in the process of medical decision making as briefly illustrated by 2 clinical scenarios of hematologic malignancies.

Physician uncertainty aversion impacts medical decision making for older patients with acute myeloid leukemia: results of a national survey

“…Uncertainty is a crucial, multifaceted component of the therapeutic decision for older patients with AML. 14 Intensive chemotherapy offers the greatest chance of complete remission (CR) but is associated with a significant risk of early death (ED), while hypomethylating agents yield a lower chance of CR but lower risk of ED. Thus, for physicians treating an older AML patient, uncertainty is a pre-condition for the decision itself, which underscores the need to investigate how physicians deal with it.…”

The Rhetoric of the ‘Passive Patient’ in Indian Medical Negligence Cases

“…Therefore, 'respect for persons' first requires the recognition and acceptance that each individual possesses certain values, beliefs, and meanings, which endow them with the right to be treated as a 'person', and these characteristics lead each person to act in a specific manner within a given context. Moreover, each individual, even a doctor, has certain limitations that they cannot account for, and uncertainties within medicine should be acknowledged (Braddock III et al 1999;Han 2012;Dhawale, Steuten, and Deeg 2017;Politi, Han, and Col 2007).…”

Examining the patterns of uncertainty across clinical reasoning tasks: effects of contextual factors on the clinical reasoning process

“…Reasoning through and having to make decisions based on numerous interwoven factors can lead physicians to feelings of uncertainty [12,13]. Uncertainty, "an awareness of incomplete understanding of a situation or event" (p. 866), manifests sometimes in clinical reasoning as difficulty determining diagnosis and treatment plans [14]. Thus, it has become a topic of increasing interest in medicine where efforts are focused on understanding uncertainty's role in clinical encounters as well as addressing ways of overcoming it [15].…”

“…Thus, it has become a topic of increasing interest in medicine where efforts are focused on understanding uncertainty's role in clinical encounters as well as addressing ways of overcoming it [15]. Among other sources, uncertainty in clinical reasoning arises from case complexity or ambiguity, a lack of information or experience with a specific case, and the complex and emergent relationship between patient and physician [13][14][15] Another source that could lead to uncertainty is presence of contextual factors in a clinical encounter (i.e., factors other than case content associated with the physician, patient, and environment; see Figure 1) [5]. These contextual factors (e.g., misleading diagnostic suggestion, language barrier, burnout, etc.)…”