title: Uncertainty in clinical practice - an interview study with Swedish GPs on patients with sore throat.
abstract: Uncertainty is inevitable in clinical practice in primary care and tolerance for uncertainty and concern for bad outcomes has been shown to vary between physicians. Uncertainty is a factor for inappropriate antibiotic prescribing. Evidence-based guidelines as well as near-patient tests are suggested tools to decrease uncertainty in the management of patients with respiratory tract infections. The aim of this paper was to describe strategies for coping with uncertainty in patients with pharyngotonsillitis in relation to guidelines.
  
  
  
  An interview study was conducted among a strategic sample of 25 general practitioners (GPs).
  
  
  
  All GPs mentioned potential dangerous differential diagnoses and complications. Four strategies for coping with uncertainty were identified, one of which was compliant with guidelines, "Adherence to guidelines", and three were idiosyncratic: "Clinical picture and C-reactive protein (CRP)", "Expanded control", and "Unstructured". The residual uncertainty differed for the different strategies: in the strategy "Adherence to guidelines" and "Clinical picture and CRP" uncertainty was avoided, based either on adherence to guidelines or on the clinical picture and near-patient CRP; in the strategy "Expanded control" uncertainty was balanced based on expanded control; and in the strategy "Unstructured" uncertainty prevailed in spite of redundant examination and anamnesis.
  
  
  
  The majority of the GPs avoided uncertainty and deemed they had no problems. Their strategies either adhered to guidelines or comprised excessive use of tests. Thus use of guidelines as well as use of more near-patient tests seemed associated to reduced uncertainty, although the later strategy at the expense of compliance to guidelines. A few GPs did not manage to cope with uncertainty or had to put in excessive work to control uncertainty.
authors.affiliation: Department of Medicine and Health Sciences, Family Medicine, Linköping University, Linköping, Sweden. malin.e.andre@gmail.com.|Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Box 564, 75122, Uppsala, Sweden. malin.e.andre@gmail.com.
authors.forename: Malin
authors.initials: M
authors.lastname: Andre
authors.affiliation: Department of Sociology, Uppsala University, Uppsala, Sweden.
authors.forename: Hedvig
authors.initials: H
authors.lastname: Gröndal
authors.affiliation: Lund University, Department of Clinical Sciences, Family Medicine, Malmö, Sweden.|Blekinge Centre of Competence, Blekinge County Council, Karlskrona, Sweden.
authors.forename: Eva-Lena
authors.initials: EL
authors.lastname: Strandberg
authors.affiliation: Lund University, Department of Clinical Sciences, Family Medicine, Malmö, Sweden.|Center for Primary Health Care Research, Skåne Region, Malmö, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Brorsson
authors.affiliation: Lund University, Department of Clinical Sciences, Family Medicine, Malmö, Sweden.|Department of Research and Development, Kronoberg County Council, Växjö, Sweden.
authors.forename: Katarina
authors.initials: K
authors.lastname: Hedin
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000942:Antigens, Bacterial / Q000097:blood*; D001291:Attitude of Health Personnel; D002097:C-Reactive Protein / Q000378:metabolism; D000066491:Clinical Decision-Making; D003937:Diagnosis, Differential; D005239:Fear; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D019983:Guideline Adherence; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000382:microbiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D013297:Streptococcus pyogenes / Q000276:immunology*; D013548:Sweden; D014069:Tonsillitis / Q000382:microbiology; D035501:Uncertainty
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial; D002097:C-Reactive Protein
keywords: C-reactive protein; General practitioners; Guideline; Qualitative research; Sore throat; Uncertainty