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Clinical decision-making: coping with uncertainty
  1. A F West1,
  2. R R West2
  1. 1Child and Adolescent Mental Health Service, Wokingham Hospital, Wokingham, Berkshire RG41 2RE, UK
  2. 2Epidemiology, University of Wales College of Medicine, Cardiff, UK
  1. Correspondence to:
 Dr Andrew West

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Despite increasing medical knowledge uncertainty will always remain


Reliable research and audit information are essential to increasing medical knowledge and improving health service delivery. However there are limits to available information in terms of quality, reliability, and applicability. Furthermore, however much information is gathered, there will always be a degree of uncertainty at the point of making clinical decisions with individual patients. Unrealistic lay and professional expectations of the efficacy of information and that certainty is achievable, may be altering the traditional clinician-patient relationship. One therapeutic role of a clinician is containing the anxieties aroused in the context of uncertainty, and this role may be becoming more difficult. Reliance on protocols and fear of reprimand may lead to clinicians, in some areas of medical care, abandoning their patients at a time of need.


Many acknowledge that there has been an information explosion in the health services over the last few decades. Vastly increased volumes of information are gathered in pursuit of knowledge and in the name of audit. The former provides the backbone of “evidence based medicine” and the latter facilitates clinical governance.1–3 Almost certainly, more information is being gathered than will ever be put to use. The authors of this paper—one a clinician, the other an epidemiologist—view these developments from different perspectives and share a concern. They recognise the extent to which properly collected and handled research information and properly collected and handled audit information could and should improve health service delivery,4 yet are also aware of the limits to the information, both in its comprehensiveness and in its usefulness. What is more, they join to describe how the current emphasis on apparently factual information lets down both doctor and patient because it denies the importance of a crucial aspect of the relationship, namely the management …

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