The transition from working in the hospital to the community setting is highly challenging for the new GP registrar. The general practice environment is characterised by a wide breadth of (often unfamiliar) clinical problems; complex and chronic disease management; relative independence of decision-making; time pressures; complex practice systems; and financial and billing issues.2 On top of all of this, GP registrars must also learn how to manage uncertainty, one of the defining features of general practice.
If there is one certainty in general practice, it is the inherent presence of uncertainty. Undifferentiated presentations are very common in primary care and a firm diagnosis is elusive in many encounters.3 Symptoms are often vague, examination findings unclear, investigation results conflicting, and response to treatment inconsistent. Guidelines may be irrelevant or non-existent. Clinical decision-making may be compromised for a myriad of reasons. As a result, uncertainty is intrinsic to the general practice encounter. Indeed, it has even been proposed that managing uncertainty is the ‘specialty’ of general practice.4
Not surprisingly, (in)tolerance of uncertainty varies from doctor to doctor. The ability to manage uncertainty has been found to influence a range of patterns of practice, including test-ordering behaviour.5,6 Most importantly, a lower tolerance of uncertainty has been identified as a cause of stress and burnout in GPs7, and GP registrars8.
Tolerating and managing uncertainty, while related to the individual doctor’s personality, is also a learned skill. Management of uncertainty is a core competency of both the RACGP Curriculum Core Skills Unit9 and the Australian College of Rural and Remote Medicine primary curriculum.10 As part of the apprenticeship model of Australian general practice training, you can therefore play a critical role in developing this skill in your registrars.
This GPSA guide aims to support GP supervisors to identify, assess, and facilitate development of, skills in managing uncertainty.
Thank you to our supporters. General Practice Supervisors Australia (GPSA) is supported by funding from the Australian Government under the Australian General Practice Training (AGPT) program.
GPSA produce a number of relevant guides for GP supervisors and practices, visit www.gpsupervisorsaustralia.org.au to view additional guides.
Thank you to Dr Simon Morgan and Dr Justin Coleman for their contributions in writing this GP supervisor guide.
2. Illing J, Taylor G, van Zwanenberg T. A qualitative study of preregistration house officers in general practice. Med Educ 1999; 33: 894-900.
3. McWhinney IR. A textbook of Family Medicine. 2nd edition London: Oxford University Press, 1997.
4. Pimlott N. Managing uncertainty. Can Fam Physician 2007; 53: 1000.
5. Geller G. Tolerance for ambiguity: An ethics-based criterion for medical student selection. Acad Med. 2013; 88: 581-4.
6. West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA. 2009: 302: 1294-1300.
7. Bachman KH, Freeborn DK: HMO physicians’ use of referrals. Soc Sci Med 1999; 48: 547-557.
8. Cooke G, Doust J, Steele M. A survey of resilience, burnout, and tolerance of uncertainty in Australian general practice registrars. BMC Med Educ 2013; 13: 2.
9. Royal Australian College of General Practitioners (RACGP) website. Core Skills Unit, Melbourne, 2016. Available at http://www.racgp.org.au/education/curriculum/2016-curriculum/ [accessed 10 September 2016].
10. Australian College of Rural and Remote Medicine (ACRRM). Primary Curriculum. Available at http://www.acrrm.org.au/ PrimaryCurriculum/Default.htm [accessed 28 March 2016].