title: Risk taking and tolerance of uncertainty: implications for surgeons.
abstract: BACKGROUND
  Adherence to evidence-based adverse outcome prevention techniques is a critical factor in providing high-quality patient care, but many of these interventions are not used by physicians. It is unclear if surgeons' risk attitudes and reactions to uncertainty influence their use of these or other interventions.
  
  
  METHODS
  A systematic review of the literature was conducted to identify studies evaluating the effects of physicians' risk attitudes, reactions to uncertainty or ambiguity, and personality traits on clinical decision making.
  
  
  RESULTS
  A variety of instruments to assess risk attitude and reactions to uncertainty have been developed and tested among physicians involved in critical care and emergency medicine. Scoring systems distinguish risk averse and risk seeking practitioners. In many studies, these characteristics were related to clinical decision making in situations of uncertainty. For example, among patients evaluated in the emergency room for chest pain, "risk-seeking" physicians admitted significantly fewer patients who did not have acute myocardial infarction than risk-avoiding physicians (29% and 47% of patients admitted, respectively). In contrast, risk-seeking physicians were no more likely to discharge a patient who eventually was found to have an acute myocardial infarction.
  
  
  CONCLUSIONS
  There are very limited data on the extent to which surgical decision making is linked to risk taking behavior and "comfort with uncertainty". Understanding the behaviors, attitudes and beliefs that make up surgical "judgment" remains a challenge for those interested in influencing behavior.
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington 98195-6410, USA.
authors.forename: Eric P
authors.initials: EP
authors.lastname: Tubbs
authors.forename: Jo Ann Broeckel
authors.initials: JA
authors.lastname: Elrod
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
mesh_terms: D001291:Attitude of Health Personnel; D003625:Data Collection; D003657:Decision Making; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D017063:Outcome Assessment, Health Care; D010551:Personality; D010820:Physicians; D017410:Practice Guidelines as Topic; D011594:Psychometrics; D011787:Quality of Health Care; D012309:Risk-Taking; D013514:Surgical Procedures, Operative / Q000592:standards*