title: Expressing uncertainty in clinical interactions between physicians and older patients: what matters?
abstract: OBJECTIVE
  Uncertainty is one key factor influencing physician and patient behavior. We examined the propensity to express uncertainty on mental health versus biomedical issues by elderly patients (>65 years) and physicians during primary care visits.
  
  
  METHODS
  385 videotaped visits were coded according to "topics," which are issues raised by any participant during the visit. This approach allowed us to examine if uncertainty was expressed in biomedical, mental health or other topics, and the factors associated with expressions of uncertainty.
  
  
  RESULTS
  We found that patients expressed uncertainty in 20.21% of topics compared to physicians expressing uncertainty in 11.73% of topics discussed in all visits. Patients expressed uncertainty in 22% of biomedical and 46.5% (p<0.01) of mental health topics. Similar statistics were found in physicians' expression of uncertainty with more uncertainty being expressed with mental health topics (23.9%) than biomedical topics (12.56%, p<0.05).
  
  
  CONCLUSIONS
  Patients expressed more uncertainties than physicians during visits. Patients and physicians both expressed more uncertainties on mental health topics suggesting that patients and primary care physicians felt less knowledgeable or less confident about dealing with mental health issues.
  
  
  CONCLUSIONS
  Understanding the inherent uncertainties in medicine can help physicians and patients engage in more productive discussion about both biomedical and mental health topics.
authors.affiliation: Health Policy Research, Palo Alto Medical Foundation Research Institute, Palo Alto, CA 94301-2302, USA. Tai-SealeM@pamfri.org
authors.forename: Ming
authors.initials: M
authors.lastname: Tai-Seale
authors.forename: Cheryl
authors.initials: C
authors.lastname: Stults
authors.forename: Weimin
authors.initials: W
authors.lastname: Zhang
authors.forename: Martha
authors.initials: M
authors.lastname: Shumway
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D009819:Office Visits; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010820:Physicians; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research; D035501:Uncertainty; D014743:Videotape Recording