The experience of uncertainty amongst doctors working within primary healthcare in Malta

Abstract

BACKGROUND: This is a cross-sectional observational quantitative study, with the aims of assessing experiences of uncertainty amongst doctors practising in primary healthcare in Malta and identifying contributing factors and management strategies for uncertainty.

METHODS: An online anonymous questionnaire was formulated and doctors working in primary healthcare in Malta were invited to participate. Demographic data relating to years of practising experience, local training and public or private practice, was asked for. The revised physicians’ reaction to uncertainty (rPRU) questionnaire, developed by Gerrity et al. in 1995, was used to obtain quantitative data on doctors’ experiences of uncertainty, on which hypothesis testing was carried out to identify subgroups who experienced more uncertainty. Finally, respondents were asked which factors contribute to uncertainty in their practice and which management strategies they use.

RESULTS: Data from 77 respondents was obtained. Hypothesis testing of rPRU scores showed statistically significant differences between males and females (p = 0.033), trainees and their seniors (p = 0.004), and groups with varying practice experience (p = 0.018). No statistically significant difference was noted between doctors in private and public sectors, and doctors trained or training and those not trained with the local specialist training programme. Ambiguous illness presentation, separation of medical notes between primary and hospital care, and lack of continuity of care, contribute most to uncertainty in family medicine according to respondents. To address uncertainty, most respondents encourage patient reviews, share decision-making and explain red flags to patients.

CONCLUSION: Better support is needed for doctors to manage uncertainty in their practice, where continuity of care is an essential strategy.