On the challenges of using evidence-based information: The role of clinical uncertainty

Amit Ghosh

Research output: Contribution to journalReview article

50 Citations (Scopus)

Abstract

Evidence-based medicine helps physicians appraise the latest and best evidence and incorporate patient's values in reaching a shared clinical decision. However, many decisions in medicine are made in the paucity of best evidence. Medical uncertainty remains inherent in clinical practice and contributes to significant variability in the way physicians and patients manage medical problems. Physicians and patients have varying degrees of tolerance for uncertainty. Intolerance to uncertainty among physicians results in increased test ordering tendencies, variability in medical treatment, failure to comply with evidence-based guidelines, and even guide career choices. Factors that result in the variability of physicians' interpretation of an effective treatment include: patient factors (prioritizing some factors over others), physician factors (lack of knowledge, lack of resources, medical uncertainty), and environmental factors (limitation of time and practice). Several approaches that have been found useful in implementing evidence in clinical practice include: sending reminders to prompt physicians to perform patient-related clinical activities, introducing computer information systems to support practice, and using interactive education interventions to teach newer skills and challenge negative attitudes. Passive educational approaches, like dissemination of guidelines and didactic lectures, are usually less useful in changing behavior. Among the techniques found to be useful for managing uncertainty are shared decision making, meticulous history taking, and physical examination, excluding worrisome differential diagnosis and establishing trust in patients. The role of future studies in assessing the outcome of multiple evidence-based strategies in situations of medical uncertainty remains to be explored.

Original languageEnglish (US)
Pages (from-to)60-64
Number of pages5
JournalJournal of Laboratory and Clinical Medicine
Volume144
Issue number2
DOIs
StatePublished - Aug 2004

Fingerprint

Uncertainty
Physicians
Medicine
Patient treatment
Guidelines
Career Choice
Medical problems
Evidence-Based Medicine
Computer Systems
Treatment Failure
Information Systems
Information systems
Physical Examination
Education
Decision making
Decision Making
Differential Diagnosis

Keywords

  • EBM
  • evidence-based medicine
  • LCME
  • Liaison Committee on Medical Education

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medicine(all)

Cite this

On the challenges of using evidence-based information : The role of clinical uncertainty. / Ghosh, Amit.

In: Journal of Laboratory and Clinical Medicine, Vol. 144, No. 2, 08.2004, p. 60-64.

Research output: Contribution to journalReview article

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