Managing Uncertainty as a Physician
Uncertainty is a fact of life if you are a physician. Patients don’t always get better, there is not always one best choice or right answer, and sometimes our decisions are affected by factors that are completely out of our control.
Managing uncertainty is a skill set that doesn’t come easy for many of us. Perfectionism is likely a way of life, and to be truthful, that’s not always a bad thing. We want to do the best for our patients, we want excellent outcomes, and we want to be acknowledged for the care we provide. But when we set unrealistic standards, it can actually be a barrier to optimal care and to our own well-being.
A recent study examined the connection between tolerance for uncertainty and burnout in 2000 faculty physicians. Not surprisingly, intolerance for uncertainty was associated with a three-fold increased likelihood of burnout.
As you might expect, those who struggled with uncertainty were much less likely to be satisfied with their career, and tended to be less engaged at work. Factors that correlated with a greater intolerance of uncertainty were
Female gender
Primary care
Earlier stage of practice
Lack of a trusted advisor.
Although these were important risk factors, many men, specialists, and later stage physicians were also burdened by intolerance of uncertainty.
Burnout and physician unhappiness are crucial pain points in our current healthcare environment. Not surprisingly, stress from uncertainty correlates with depression and low levels of resilience. Intolerance of uncertainty has been linked to poorer outcomes and even to increased healthcare costs. And burned out physicians are more likely to leave the practice of medicine.
Our innate perfectionism combined with the prevailing medical culture of stoicism means that physicians may be reluctant to admit that they are dealing with uncertainty. This makes it all the more important for more senior colleagues and mentors to acknowledge that despite all we know and no matter how hard we try, uncertainty will always be a part of the life of a physician. Simply sharing that insight can make it a little easier to come to terms with the fact that we cannot control everything.
Although becoming comfortable with uncertainty may always be a challenge, managing your response to uncertainty can open up opportunities to react to life’s curve balls in ways that are both positive and beneficial to all involved.
In their thorough analysis of the issue, Samuel Reis-Dennis and colleagues describe “three corrective virtues” that might help physicians navigate the challenges that uncertainty creates. These include:
Courage: avoiding the tendency to run away from threats by developing strategies to cope with new challenges
Diligence: seeking guidance from trusted colleagues and staying current on the medical literature
Curiosity: addressing uncertainty by viewing it as an opportunity to learn and grow
It’s not an easy task to recognize the factors that may be holding you back. And it’s even more difficult to be objective and to find your own way while living the unpredictable and demanding life of a physician. Medical schools are increasingly understanding the importance of teaching these skills, but it’s not always enough once you hit the real world. Working with a coach or trusted advisor may help to get you on track, discovering the solutions and opportunities that best fit your needs.
An earlier version of this article originally appeared on this site in July 2022.
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References
Allison, J. J., Kiefe, C. I., Cook, E. F., Gerrity, M. S., Orav, E. J., & Centor, R. (1998). The association of physician attitudes about uncertainty and risk taking with resource use in a Medicare HMO. Medical decision making : an international journal of the Society for Medical Decision Making
Begin, A. S., Hidrue, M., Lehrhoff, S., Del Carmen, M. G., Armstrong, K., & Wasfy, J. H. (2022). Factors associated with physician tolerance of uncertainty: an observational study. Journal of general internal medicine
Berg, S. (2020). Feeling burned out? Try picking up the phone to call your coach. American Medical Association
Cook, J. (2022). Forget resilience, improve your uncertainty tolerance. Forbes
Iannello, P., Mottini, A., Tirelli, S., Riva, S., & Antonietti, A. (2017). Ambiguity and uncertainty tolerance, need for cognition, and their association with stress. A study among Italian practicing physicians. Medical education online
Reis-Dennis, S., Gerrity, M. S., & Geller, G. (2021). Tolerance for uncertainty and professional development: a normative analysis. Journal of general internal medicine
Simpkin, A. L., Khan, A., West, D. C., Garcia, B. M., Sectish, T. C., Spector, N. D., & Landrigan, C. P. (2018). Stress from uncertainty and resilience among depressed and burned out residents: a cross-sectional study. Academic pediatrics
Sinsky, C. A., Brown, R.L., Stillman, M. J., & Linzer, M. (2021) COVID-related stress and work intentions is a sample of US health care workers. Mayo Clinic proceedings