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Managing ambiguity and uncertainty in clinical decision-making

02 April 2023
Volume 15 · Issue 4


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.

Ambiguity and uncertainty are two intricately linked—albeit subtly different—factors that impact clinical practice on an almost daily basis. Ambiguity is a state of doubt that arises in a situation that can be interpreted in diverse ways (Cambridge Dictionary, 2023; Oxford Learner’s Dictionaries, 2023), whereas uncertainty concerns the feelings and perceptions experiences because of the ambiguity (Merriam-Webster, 2023).

Most decisions in clinical practice are made in a condition of indeterminacy where practitioners cannot completely predict what will happen (Liu, 2015). It is impossible to eradicate ambiguity and uncertainty (Bradley and Dreschler, 2014).

The majority of people feel uncomfortable when faced with ambiguity and uncertainty. Their personal sense of control and confidence influences how they experience the ambiguity (Penrod, 2007). Most of our patients will be feeling uncertain too (Tyreman, 2015) and, while the focus of this paper is not on how to manage their uncertainty, it is worth remembering that they may also be feeling anxious in unfamiliar situations where they are unsure what may happen next.

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