Managing ambiguity and uncertainty in clinical decision-making

Ambiguity and uncertainty are unavoidable elements of clinical practice. Although they can cause discomfort for both clinicians and patients, they can also be used to positive effect ensuring safer clinical practice that is tailored to individuals. As paramedics generally work in areas of practice where they encounter undifferentiated complaints with limited resources to investigate, diagnostic uncertainty can prove a challenge on a regular basis. Similarly, even when paramedics are fairly confident of the diagnosis, optimal management is frequently unclear or unachievable. This article presents practical short-term strategies to manage both diagnostic and management uncertainty in clinical practice. This article also suggests longer-term tactics that can be developed individually and collectively beginning with developing capability over competence through to changing culture and providing space for supervision. While these strategies may not completely eliminate the discomfort that can arise when faced with ambiguity and uncertainty, they can enable a greater tolerance for it, improve clinical practice, and ultimately benefit patients.

Naomi Lafitte -