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

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This study examines how hospital medicine attending physicians experience and manage clinical uncertainty in practice. Hospital medicine emerged in the mid-1990s and has grown rapidly, but the clinical environment has become more difficult: hospitalized patients are more complex, electronic health record demands are heavier, and physicians have less time for teaching. Because uncertainty is a common but stressful part of medical practice and is linked to burnout, the authors seek to better understand how hospitalists handle it.<br /><br />Using a constructivist grounded theory approach, the researchers are interviewing hospitalist attendings at Mayo Clinic Rochester during a week on service. Interviews focus on challenging cases and are analyzed concurrently using MAXQDA, with guidance from prior uncertainty research in other fields. The team includes hospitalists, an education scientist, and uncertainty experts from emergency medicine and primary care.<br /><br />Preliminary findings suggest that uncertainty is driven by questions such as how to help the patient understand, what the patient is thinking, and what to do when others disagree. Common responses include sharing uncertainty, consulting colleagues, careful documentation, delicate or paternalistic communication, and attention to psychosocial factors, unclear disposition, decision-making capacity, refractory symptoms, and difficult family dynamics. Hospitalists also described “uncertainty prophylaxis,” such as reading about patients before starting service, starting notes early, triaging urgency, planning ahead, setting boundary conditions, and using therapeutic trials.<br /><br />The authors conclude that better communication training, improved discharge support, and workflow changes may help hospitalists manage uncertainty more effectively. They also suggest that encouraging structured strategies like triage and boundary-setting may improve decision-making and support higher-value care while reducing burnout.

Asset Subtitle

Elizabeth Beiermann

Meta Tag

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

Category Research

Concept Hospital Medicine

Concept Clinical Uncertainty

Concept Hospitalist

Concept Patient Complexity

Concept Communication

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Elizabeth Beiermann

Track Translating Research into Practice

Keywords

hospital medicine

clinical uncertainty

hospitalists

burnout

constructivist grounded theory

electronic health records

patient communication

discharge support

decision-making capacity

workflow changes

Hospital Medicine

Clinical Uncertainty

Hospitalist

Patient Complexity

Communication