Document Type : Original Article



BACKGROUND: Clinical decision‑making is not only stressful to physicians, but also to patients and
even their companions. Thus, managing uncertainty in clinical decision‑making is essential which
requires knowing its origins. Therefore, this study aimed to understand determinants of uncertainty
in clinical decision‑making from the perspective of clinical physicians.
MATERIALS AND METHODS: This is a qualitative study which is done during October to November
2020. An in‑depth interview is performed with 24 specialists of clinical groups including obstetrics,
surgery, internal medicine, and pediatrics, working in teaching hospitals affiliated to Iran University
of Medical Sciences. All the interviews were recorded, transcribed and analyzed according to the
steps suggested by Graneheim and Lundman. The interviews were analyzed through comparative
method. Then, the interviewer created initial codes, categories, and key concepts and sent them to
fourteen physicians for member check.
RESULTS: According to the participants’ view, determinants of uncertainty in clinical decision‑making
consisted of three themes: individual determinants, dynamics of medical sciences, and diagnostic
and instrumental constraint. Individual determinants can be related to the physician or patient. The
dynamics of medical sciences could be explained in two categories: variation of medical science and
complexity. Diagnostic and instrumental constraint category could be also explained in subcategories
such as lack of efficient diagnostic tests and unknown etiology.
CONCLUSION: To curb uncertainty, the more accessible way is considering interventional programs
with a focus on individual determinants related to physicians, such as strengthening doctor–patient
relationships, and considering related mandatory retraining courses to reduce insufficient knowledge
of physicians.


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