Tolerance of Uncertainty and the Practice of Emergency Medicine

Platts‐Mills, Timothy F.; Nagurney, Justine M.; Melnick, Edward R.

doi:10.1016/j.annemergmed.2019.10.015

Cited by 23 publications

(20 citation statements)

References 41 publications

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“…Emergency physicians report high work pressure, long working shifts, increasing patient volumes and acuity of problems, staff shortages, and often a chaotic work environment characterized by unpredictability. 1,2 Recent reviews of work stress in emergency physicians show that higher levels of stress (in excess of 60%) are reported compared to physicians in general (38%), which can be attributed to the stressful work conditions but also to high psychological demands, lack of job control, and poor social support, despite a relatively high job satisfaction. 1,3,4 Johnston et al stated that autonomy and teamwork might buffer these adverse well-being-health consequences.…”

Section: Introductionmentioning

confidence: 99%

“…We also included professional well-being consequences including psychological strain (subjective fatigue and stress: anxiety and depression) and other important job-related outcomes in emergency medicine personnel such as job satisfaction, work engagement, and turnover intention. 2,11 To our knowledge, this is the first study on the well-being consequences in emergency physicians that is based on such an extended model, assessing both work conditions and environmental and organizational work characteristics as determinants of relevant professional well-being outcomes. [7][8][9]…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, an extended JDCS model, including environmental and organizational hazards, was used. We also included professional well‐being consequences including psychological strain (subjective fatigue and stress: anxiety and depression) and other important job‐related outcomes in emergency medicine personnel such as job satisfaction, work engagement, and turnover intention 2,11 …”

Section: Introductionmentioning

confidence: 99%

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Determinants of emergency physician wellness in Belgium

Somville

Stiers

Franck³

et al. 2020

JACEP Open

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Objectives This cross‐sectional study examines first whether emergency physicians differ from a comparison group of surgeons, more specifically general surgeons and orthopedic surgeons, in terms of job and organizational characteristics and second to what extent these characteristics are determinants of professional well‐being outcomes in emergency physicians. Methods Belgian emergency physicians (n = 346) were invited to participate in this study. Forty‐three percent of the eligible participants completed a questionnaire. The survey instrument contained 48 questions on determinants (personal characteristics, job conditions [Job Demand Control Support], organizational and environmental work conditions) as well as 39 questions on outcomes (job satisfaction, turnover intention, subjective fatigue, psychological distress, work–home interference, work engagement) by means of the Leiden Quality of Work Questionnaire for Medical Doctors, the Checklist Individual Strength, the Brief Symptom Inventory, and the Utrecht Work Engagement Scale. Hierarchical multiple regression analyses were used to examine the association between the determinants and each of the outcomes. Results Emergency physicians reported higher job demands, lower job control, and less adequate work conditions compared with the group of surgeons. High job demands increased turnover intention, subjective fatigue, psychological distress, work–home interference in emergency physicians, but lack of job control, lack of social support from the supervisor, and inadequate communication also contributed in an unfavorable way to some of these outcomes. Conclusion Emergency medicine departments must reduce the constant exposure to high job demands by allowing emergency physicians to have enough time for both physical and mental recovery. Work motivation and work conditions might be improved by increasing job control over job demands by giving emergency physicians more decision latitude and autonomy, improving good communication and teamwork and adequate social support from the supervisor and providing good material resources. These interventions can improve professional well‐being outcomes in emergency physicians.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Determinants of emergency physician wellness in Belgium

Somville

Stiers

Franck³

et al. 2020

JACEP Open

View full text Add to dashboard Cite

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“…That primary care clinicians must develop skills to manage it has been noted elsewhere, particularly in terms of reducing stress and preventing over-investigation ( 3 , 42 , 43 ). Teaching in medical school engrains the idea that there is a single correct answer, and that certainty is always obtainable—this is not the reality in practice, and several papers have called for changes to be made to medical training to reflect this ( 2 , 3 , 44 ). Empirical studies support the idea that medical training does not adequately cover the communication of uncertainty to patients ( 36 , 38 ).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic uncertainty in primary care: what is known about its communication, and what are the associated ethical issues?

Cox

Miller²,

Kuhn

et al. 2021

Family Practice

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Background Diagnostic uncertainty (DU) in primary care is ubiquitous, yet no review has specifically examined its communication, or the associated ethical issues. Objectives To identify what is known about the communication of DU in primary care and the associated ethical issues. Methods Systematic review, critical interpretive synthesis and ethical analysis of primary research published worldwide. Medline, Embase, Web of Science and SCOPUS were searched for papers from 1988 to 2020 relating to primary care AND diagnostic uncertainty AND [ethics OR behaviours OR communication]. Critical interpretive synthesis and ethical analysis were applied to data extracted. Results Sixteen papers met inclusion criteria. Although DU is inherent in primary care, its communication is often limited. Evidence on the effects of communicating DU to patients is mixed; research on patient perspectives of DU is lacking. The empirical literature is significantly limited by inconsistencies in how DU is defined and measured. No primary ethical analysis was identified; secondary analysis of the included papers identified ethical issues relating to maintaining patient autonomy in the face of clinical uncertainty, a gap in considering the direct effects of (not) communicating DU on patients, and considerations regarding over-investigation and justice. Conclusions This review highlights significant gaps in the literature: there is a need for explicit ethical and patient-centred empirical analyses on the effects of communicating DU, and research directly examining patient preferences for this communication. Consensus on how DU should be defined, and greater research into tools for its measurement, would help to strengthen the empirical evidence base.

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“…Emergency physicians are required to make complex, cognitively challenging decisions regarding diagnostic assessment and management of patients in a crowded, time-constrained environment [ 23 ]. The development of clinical practice guidelines and decision aids is aimed at reducing practice variation and improving patient outcomes, while simultaneously minimizing unnecessary and potentially harmful testing.…”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators affecting implementation of the Canadian clinical practice guidelines for the diagnosis of acute aortic syndrome

Dmitriew

Ohle

2021

Implement Sci Commun

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Background Acute aortic syndrome (AAS) is an uncommon, life-threatening emergency that is frequently misdiagnosed. The 2020 Canadian clinical practice guidelines for the diagnosis of AAS incorporate all available evidence into four key recommendations. In order to facilitate the implementation of these recommendations, a clinical decision aid was created. The objective of this study was to identify barriers and facilitators among physicians prior to implementation of the guideline recommendations in a multicentre step wedge cluster randomized control trial. Methods We conducted semi-structured interviews with nine emergency room physicians working at five sites distributed between urban academic and rural settings. We used purposive sampling, contacting physicians until data saturation was reached. Interview questions were designed to understand potential barriers and facilitators to guideline recommendation uptake and use. Responses were analysed according to the Theoretical Domains Framework, and overarching themes describing these barriers and facilitators were identified. Results Two themes and six subthemes encompassing 13 theoretical domains were identified. These included clinical decision-making support, awareness of the evidence, social factors, expected consequences, ability of physicians to acquire the necessary data and ease of use. A majority of interviewees anticipated that the guideline recommendations would support clinical decision making and more effectively risk-stratify patients. Other facilitators included endorsement of the guidelines by professional organizations and peers. Barriers to implementation include the fact that laboratory testing and knowledge of the rationale for its use in the investigation of AAS were not widespread. The complexity of the clinical decision aid and concerns about test specificity were also identified as potential barriers to use. Conclusion Physicians were amenable to using the AAS guideline recommendations to support clinical decision-making and to reduce resource use. A structured intervention should be developed to address the identified barriers and leverage the facilitators in order to ensure successful implementation. Our findings may have implications for the implementation of other guidelines used in emergency departments.

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Tolerance of Uncertainty and the Practice of Emergency Medicine

Cited by 23 publications

References 41 publications

Determinants of emergency physician wellness in Belgium

Determinants of emergency physician wellness in Belgium

Diagnostic uncertainty in primary care: what is known about its communication, and what are the associated ethical issues?

Barriers and facilitators affecting implementation of the Canadian clinical practice guidelines for the diagnosis of acute aortic syndrome

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