Uncertainty and clinical method
© Springer Science+Business Media New York 2013. Trisha Greenhalgh reviews the literature on clinical uncertainty by describing the visits with four of her primary care patients. She presents a four-part taxonomy of uncertainty illustrated in the context of these patients' visits. Uncertainty about the evidence – the ‘voice of medicine’ dimension of the visit – relates to the completeness, accuracy, relevance of research-based evidence, and balance between potential benefits and harms. Uncertainty about the patient's story – the ‘voice of the lifeworld’ dimension – raises questions about how to explore the contexts and complexities of patients’ lives. Uncertainty about what best to do for the particular patient raises questions about using clinical judgment (the summation of knowledge, skill, and practical wisdom) to address each patient's unique set of issues. Uncertainties embodied in risks to quality and safety arising when care becomes a collaborative endeavour with its mix of human-human, technology-human, and technology-technology interactions add to the substrate for the clinical method.