SHM Converge Scientific Abstract ePoster Gallery-How Do Hospitalists Experience and Manage Uncertainty in Practice?

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This Mayo Clinic study explored how hospitalists experience and manage clinical uncertainty in practice. The investigators interviewed 12 academic hospitalists at a single quaternary care center in Rochester, Minnesota, between April 2023 and February 2025. Using semi-structured interviews and thematic analysis, they identified three major themes.<br /><br />First, hospitalists described uncertainty as varied and interconnected rather than isolated. Uncertainty involved patient illness, communication, and care processes, and often multiple uncertainties overlapped and evolved over time.<br /><br />Second, uncertainty was experienced as both a cognitive and emotional burden. Participants used terms such as “burden” and “bandwidth” to explain that managing uncertainty depends on available time, attention, and mental capacity. Uncertainties that were solvable or encountered early in hospitalization, such as on admission, were seen as less taxing. In contrast, uncertainty in the hospital setting can be especially difficult because there is strong pressure to make decisions and discharge patients even when full clarity is not possible.<br /><br />Third, hospitalists used a range of management strategies. Approaches aimed at reducing uncertainty included looking up information, consulting experts, doing therapeutic trials, watchful waiting, setting boundary conditions, and using perspective taking or shared decision-making. Strategies aimed at preserving bandwidth included turning off notifications, preparing ahead of service, offloading uncertainty through consultation, and sometimes “kicking the can” to delay decisions.<br /><br />Overall, the study suggests that uncertainty is a central and demanding part of hospital medicine, with important implications for physician well-being, decision-making, and workload. The authors argue that existing workload frameworks should better account for the role of uncertainty.

Asset Subtitle

Elizabeth W. Beiermann

Meta Tag

Author List Elizabeth W. Beiermann, Ellen L. Usher, Jeffrey D. Krimmel-Morrison, John Ilgen, John Ratelle

Category Research

Concept Uncertainty

Concept Hospitalist

Concept Cognitive Burden

Concept Emotional Burden

Concept Clinical Bandwidth

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Elizabeth W. Beiermann

Track Education

Keywords

hospitalists

clinical uncertainty

hospital medicine

thematic analysis

semi-structured interviews

cognitive burden

emotional burden

shared decision-making

watchful waiting

physician workload

Uncertainty

Hospitalist

Cognitive Burden

Emotional Burden

Clinical Bandwidth