Clinical Uncertainty in Primary Care

The Power of Colleagues

What happens when primary care clinicians meet together on set aside time in their practice settings to talk about their own patients?

. . . . . Complimenting quality metrics or performance measures through discussing the actual stories of individual patients and their clinician-patient relationships

In these settings, how can clinicians pool their collective experience and apply that to 'the evidence' for an individual patient?

. . . . . Especially for patients who do not fit the standard protocols and have vague and worrisome symptoms, poor response to treatment, unpredictable disease courses, and/or compromised abilities for shared decision making

What follows when discussion about individual patients reveals system-wide service gaps and coordination limitations?

. . . . . Particularly for patients with complex clinical problems that fall outside performance monitors and quality screens

How can collaborative engagement of case-based uncertainties with one's colleagues help combat the loneliness and helplessness that PCPs can experience, no matter what model or setting in which they practice?

. . . . . And where they are expected to practice coordinated, evidence-based, EMR-directed care

These questions inspired Lucia Sommers and John Launer and their international contributors to explore the power of colleagues in "Clinical Uncertainty in Primary Care: The Challenge of Collaborative Engagement" and offer antidotes to sub-optimal care that can result when clinicians go it alone.

From the Foreword: "Lucia Sommers and John Launer, with the accompanying input of their contributing authors, have done a deeply insightful and close-to-exhaustive job of defining clinical uncertainty. They identify its origins, components and subtypes; demonstrate the ways in which and the extent to which it is intrinsic to medicine. . . and they present a cogent case for its special relationship to primary care practice. . .'Clinical Uncertainty in Primary Care' not only presents a model of collegial collaboration and support, it also implicitly legitimates it.'' Renee Fox, Annenberg Professor Emerita of the Social Sciences, University of Pennsylvania.

Section One: Clinical Uncertainty in Primary Care1. Introduction. - 2. Uncertainty and Clinical Method. - 3. Learning about Uncertainty in Professional Practice. - Section Two: The Challenge of Engagement. - 4. Balint Groups and Peer Supervision. - 5. Research on Balint groups. - 6. The Thistle and the Maple Leaf: PBSGL in Canada and Scotland. - 7. Narrative-Based Supervision. - 8. Training in Narrative-based supervision: Conversations inviting change. - 9. Practice Inquiry: Uncertainty Learning in Primary Care Practice. - 10. Using Practice Inquiry to Engage Uncertainty in Residency Education. - 11. We re all in the same boat : Potentials and Tensions When Learning Through Sharing Uncertainty in Peer Supervision Groups. - 12. Case-Based Learning in Swedish Primary Health Care: Strengths and Challenges. - 13. Afterword.