Understanding and managing uncertainty in health care: revisiting and advancing sociological contributions

Abstract

In this collection we revisit the enduring phenomenon of uncertainty in health care, and demonstrate how it still offers coherence and significance as an analytic concept. Through empirical studies of contemporary examples of health care related uncertainties and their management, our collection explores the different ways in which uncertainty may be articulated, enacted and experienced. The papers address a diverse range of healthcare contexts ‐ Alzheimer’s disease, neonatal surgery, cardiovascular disease prevention, cancer, addiction (use of alcohol and other drugs during pregnancy), mental health/disorders and medical education – and many tackle issues of contemporary relevance, such as an ageing population, and novel medical interventions and their sequelae. These empirical papers are complemented by a further theoretical contribution, which considers the role of ‘implicit normativity’ in masking and containing potential ethical uncertainty. By mapping themes across the collection, in this introduction we present a number of core analytical strands: (1) conceptualising uncertainty; (2) intersections of uncertainty with aspects of care; (3) managing uncertainty; and (4) structural constraints, economic austerity and uncertainty work. We reflect on the methodological and theoretical stances used to think sociologically about uncertainty in health care, and the strengths, silences and gaps we observe in the collection. We conclude by considering the implications of the insights gained for ‘synthesising certainty’ in practice and for future research in this area.

Implementing interventions to reduce antibiotic use: a qualitative study in high-prescribing practices

“…The Covid-19 pandemic has brought forth new uncertainties and challenges for healthcare systems across the world [48,49], including for prescribers in primary care. Mitigating the spread of antimicrobial resistance by more prudent antibiotic use is an even greater public health priority for pandemic response and preparedness.…”

Exploring Clinical Practice and Developing Clinician Self-Reflection Through Cross Self-Confrontation Methodology: An Application Within an Addiction Medicine Unit

“…Secondly, we intended to take advantage of the reflective process at the heart of CSC to produce scientific knowledge. Exploring clinical practice uncertainty ( Fox, 1957 ; Mackintosh & Armstrong, 2020 ) and addiction-related clinical practice complexity ( O'Connor et al, 2014 ) requires methods capable of questioning the knowledge, values, and representations that underpin daily practices. Cross self-confrontation appeared to be one of these methods.…”

A Baby at All Costs? Exploring the Use and Provision of Unproven Adjuvant Treatments in the Context of IVF

“…10 Indeed, in a recent overview article considering the significance of uncertainty for understanding experiences within health care settings, Mackintosh and Armstrong suggest that clinicians and patients are mutually engaged in a range of strategies to overcome and limit the effects of uncertainty within medical encounters and systems. 27 However, Ernst questions whether clinicians can solve one uncertainty, for example, unidentified diagnosis (in this case infertility), by introducing a further uncertainty, for example, unproven therapy (in this case adjuvant fertility treatment). 19 A taxonomy to describe different facets of uncertainty in the context of medicine has been proposed by Beresford which distinguishes between technical uncertainty (i.e., uncertainty arising due to a lack of data/evidence), personal uncertainty (i.e., uncertainty arising in the doctor-patient relationship and the delivery of patient care), and conceptual uncertainty (i.e., uncertainty arising as a consequence of applying/using the data/evidence in routine care).…”