1. Managing Uncertainty Dr Katherine Teare GP Educator Fellow

2. What do you know?

3. Uncertainty Doctors uncertainty – dependent upon professional experiences, depth of knowledge, application of this to the situation, patient interaction Patient uncertainty – knowledge, expectations, nature of risk

4. Evidence Based Medicine Massive influence on choices in healthcare Not without its limitations ‘Proof’ of null hypothesis typically p<0.05 – still 1/20 risk conclusions incorrect / chance Meta analysis – may compound selective publication

5. ?General Practice? Much research in secondary care settings Often using populations not typical of our own patients E.g. research on antidepressants often starts in and focussed upon secondary care but most depressed patients seen and treated in primary care

6. Screening Patient is seeking a clear result Good screening needs high specificity (low false positives) and very high sensitivity (very low false negatives) Never without uncertainty

7. Understanding results Need to understand ‘risk’ What is an abnormal result? Many use Gaussian distribution and use cut off of 2 standard deviations above and below mean so 5% will be abnormal How is it interpreted?

8. Is it safe? Always uncertainty ‘as far as we know…’ What was the largest Island in the world before the discovery of Australia? Severity of risk affects decisions made by both patients and professionals

9. Clinical Governance Critical event monitoring introduced to RAF during 2WW by Flanagan – psychologist Adverse event – gone wrong Critical event – may have gone wrong 1974 – avg subscription to MPS/MDU was £25 – 200% increase since?!

10. Nothing is certain in life except death and taxes. Letter from Benjamin Franklin to Jean Baptiste, 13th November 1789, recorded in The works of Benjamin Franklin.

11. References http://www.doceo.co.uk/tools/knowing.htm http://www.patient.co.uk/doctor/coping -with-uncertainty-in-primary-care#