Our findings bring new insights on the importance of measuring reactions to uncertainty in medical care. Despite an abundant qualitative literature about the importance of uncertainty in medical care,1–3,11,12,14,15,17,29
we are one of a few authors who have addressed this problem quantitatively.8,9,16,30
First, we found several socio-demographic and professional characteristics associated with medical care uncertainty. Similar to findings reported years ago by Gerrity et al.7
in a study of U.S. physicians, we found that reactions to uncertainty were higher in women and among physicians in technical specialties, and lower for physicians with a greater number of years in practice. It was highest for recently graduated physicians and lowest for physicians who had an established private practice for 5 years or more. Beyond that point, the levels of stress from uncertainty remained stable. Across Medical Specialities, Psychiatrist and Internal Medicine Subspecialists displayed the lowest scores.
In addition, we found that physicians who saw many patients per week reported lower stress from uncertainty—an association that has not been previously reported. Possibly, physicians who cope with uncertainty better spend less time considering alternative diagnoses and courses of action, and are thus able to see more patients. Conversely, it may be the greater clinical experience accumulated by seeing many patients that reduces the physicians’ stress from uncertainty. Because of the cross-sectional nature of our study, we cannot determine the direction of causation based on our data.
Furthermore, we observed a significant relationship between anxiety due to uncertainty across tertiles of all dimensions of work-related satisfaction, with differences of approximately half a standard deviation in medical care uncertainty. This is also the first study to report such a strong relationship, highlighting the importance of physicians’ reactions to uncertainty in medical care. Again, we cannot establish the direction of causality from this study, but it seems far more likely that higher stress from uncertainty would cause professional dissatisfaction than the opposite.
Finally, the association between anxiety due to uncertainty and work-related satisfaction was stronger for physicians in training. Indeed, higher levels of anxiety due to uncertainty were associated with differences in work-related satisfaction of approximately 1 SD. Two basic explanations may underlie this finding: the amount of uncertainty may decrease as the physician advances in his or her clinical training and accumulates knowledge and clinical skills, or the physician learns to tolerate and cope with clinical uncertainty, as a specific clinical skill. Quite possibly, both explanations may be true. In both cases, clinical training appears to be important as a way of decreasing stress from uncertainty2,31
and its consequences on professional activities. The socio-demographic and professional determinants of medical care uncertainty suggest that dealing with medical care uncertainty can be taught. This is also typically what senior physicians observe with young interns working in medical outpatient clinic during their training program.2,12
Therefore, learning to cope with uncertainty should be an important goal of clinical training and should be regularly assessed with appropriate instruments.
Limitations and Strengths
The main weakness of our study was its cross-sectional design, which precludes a definitive evaluation of temporal precedence and causality of the observed associations. Another limitation was our exclusive reliance on self-reported rating scales, which raises the issue of systematic positive or negative response tendencies. Finally, as our data had been collected in 1998, it is possible to argue that our results may not be applicable today because of changes in medical studies or postgraduate training. We believe that this is unlikely because recent changes did not introduce specific training to deal with medical care uncertainty.
On the positive side, our results were obtained among a large unselected sample of physicians. The participation rate was acceptable, and the large number of respondents allowed us to explore even fairly weak associations with several determinants of uncertainty. Finally, the French translation of the scales, initially developed by Gerrity,7
retained their psychometric properties.