The nature of medical evidence and its inherent uncertainty for the clinical consultation : qualitative study

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Abstract

Objective To describe how clinicians deal with the
uncertainty inherent in medical evidence in clinical
consultations.
Design Qualitative study.
Setting Clinical consultations related to hormone
replacement therapy, bone densitometry, and breast
screening in seven general practices and three
secondary care clinics in the UK NHS.
Participants Women aged 45-64.
Results 45 of the 109 relevant consultations included
sufficient discussion for analysis. The consultations
could be categorised into three groups: focus on
certainty for now and this test, with slippage into
general reassurance; a coherent account of the
medical evidence for risks and benefits, but blurring
of the uncertainty inherent in the evidence and giving
an impression of certainty; and acknowledging the
inherent uncertainty of the medical evidence and
negotiating a provisional decision.
Conclusion Strategies health professionals use to
cope with the uncertainty inherent in medical
evidence in clinical consultations include the use of
provisional decisions that allow for changing
priorities and circumstances over time, to avoid
slippage into general reassurance from a particular
test result, and to avoid the creation of a myth of
certainty.

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