Annals for Hospitalists Inpatient Notes - Medical Uncertainty as a Driver of Resource Use—Examining the “Gray Zones” of Clinical Care
Authors: Charlie M. Wray, Hyung J. Cho
Journal: Annals of Internal Medicine (2018)

Web Exclusives19 June 2018Annals for Hospitalists Inpatient Notes - Medical Uncertainty as a Driver of Resource Use—Examining the "Gray Zones" of Clinical CareCharlie M. Wray, DO, MS and Hyung J. Cho, MDCharlie M. Wray, DO, MSUniversity of California, San Francisco, Department of Medicine, and Division of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California (C.M.W.) and Hyung J. Cho, MDIcahn School of Medicine at Mount Sinai, New York, New York, and Lown Institute, Brookline, Massachusetts (H.J.C.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-1320 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The Choosing Wisely campaign has created over 500 evidence-based recommendations meant to avoid unnecessary testing and treatment. However, guideline recommendations cannot possibly cover the range of decisions that hospitalists make on a daily basis. This gap leaves large areas of uncertainty that are often filled with unnecessary care. Hospitalists are positioned to lead in acknowledging and confronting these "gray zones" of uncertainty and their contribution to overuse (1).What Exactly Is Medical Uncertainty?Medical uncertainty describes situations in which guidelines may not apply to the patient at hand or when evidence to inform decisions is weak, unclear, or unavailable. Medical ...References1. Simpkin AL, Schwartzstein RM. Tolerating uncertainty - the next medical revolution? N Engl J Med. 2016;375:1713-1715. [PMID: 27806221] CrossrefMedlineGoogle Scholar2. American Board of Internal Medicine. Research Report. Accessed at www.choosingwisely.org/about-us/research-report/ on 25 September 2017. Google Scholar3. Farnan JM, Johnson JK, Meltzer DO, Humphrey HJ, Arora VM. Resident uncertainty in clinical decision making and impact on patient care: a qualitative study. Qual Saf Health Care. 2008;17:122-6. [PMID: 18385406] doi:10.1136/qshc.2007.023184 CrossrefMedlineGoogle Scholar4. Gerrity MS, DeVellis RF, Earp JA. Physicians' reactions to uncertainty in patient care. A new measure and new insights. Med Care. 1990;28:724-36. [PMID: 2385142] CrossrefMedlineGoogle Scholar5. Wolpaw TM, Wolpaw DR, Papp KK. SNAPPS: a learner-centered model for outpatient education. Acad Med. 2003;78:893-8. [PMID: 14507619] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of California, San Francisco, Department of Medicine, and Division of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California (C.M.W.)Icahn School of Medicine at Mount Sinai, New York, New York, and Lown Institute, Brookline, Massachusetts (H.J.C.)Acknowledgment: The authors thank Drs. Gurpreet Dhaliwal and Poushali Kirkpatrick for their assistance and insightful feedback on this article.Disclosures: Authors have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1320.Corresponding Author: Charlie M. Wray, DO, MS, Division of Hospital Medicine, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, 4150 Clement Street, San Francisco, CA 94121; e-mail, Charlie.[email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists - 19 June 2018 David H. Wesorick and Vineet Chopra Metrics Cited byDual Process Theory and Cognitive LoadReducing Diagnostic Error in the Intensive Care Unit. Engaging Uncertainty When Teaching Clinical ReasoningMeaningful shared decision‐making: complex process demanding cognitive and emotional skillsDiagnostic uncertainty: from education to communication 19 June 2018Volume 168, Issue 12Page: HO2-HO3KeywordsComputed axial tomographyDisclosureHospitalistsInpatientsInternetLaboratory testsPatientsPulmonary embolismRadiation therapyReflexes ePublished: 19 June 2018 Issue Published: 19 June 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...