Nejistota jako součást všeobecné praxe

Uncertainty as a component of general practice

Background:
Dealing with uncertainty and doubts is common in every day decision making processes in general practice. General practitioners encounter a vast range of problems presenting themselves in undifferentiated way. For many of these problems there are often no straight answers, no clear diagnoses and no obvious treatment; the application of guidelines and evidence based medicine is difficult.

Aim and methods:
The aim of this paper is to describe uncertainty as a component of general practice and to search for strategies to help deal with or to minimize uncertainty. A comprehensive review of the literature on uncertainty was used to prepare a focus group comprised of general practitioners. Participants produced their own solutions based upon personal experience of dealing with uncertainty. The discussion was monitored and then the outcomes were elaborated and distributed to participants for feedback.

Results:
Czech general practitioners agreed on uncertainty as a normal part of general practice. Agood doctor-patient relationship, sufficient consultation time, good communication skills and a trusting atmosphere are vital. Both external evidence (EBM, risk calculation) and internal evidence (patient’s opinion, doctor’s findings) must be assessed and respected. Peer group discussions with colleagues and specialists are another recommended option. The ability to cope with uncertainty is an essential requirement for the successful general practitioner. A failure to cope with uncertainty leads to unnecessary investigations, referrals, and to increased risk of burn-out syndrome.

Key words:
uncertainty, general practitioner, evidence-based medicine, primary care.