ArticleBMJ quality & safety2019
Are more experienced clinicians better able to tolerate uncertainty and manage risks? A vignette study of doctors in three NHS emergency departments in England.
Article in BMJ quality & safety, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 2 of them syntheses that pooled it.
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Who cites it
40 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Moderators uncertainty tolerance (UT) in healthcare: a systematic review.Advances in health sciences education : theory and practice · 2023Pooled it
- Real time self-rating of decision certainty by clinicians: a systematic review.Clinical medicine (London, England) · 2019Pooled it
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- Patterns of negative trauma laparotomy worldwide: a sub-analysis of a global dataset.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Observational
- 'I was a bit hasty … I was a young resident!' Medical residents' responses to clinical uncertainty.Medical education · 2026Article
- When emergency physicians meet patients displaying irritable behaviours: a randomised vignette-based experiment investigating physicians' emotions and clinical reasoning.BMJ quality & safety · 2026Article
- Uncertainty in Relation to Clinical Experience-A Qualitative Study on Dental Students' Reflections on Risk Assessment of Root Filled Teeth.International endodontic journal · 2026Article
- The ICUPASS Study: Variability, Influencing Factors, and Clinician Stress in ICU Admission Decisions.Cureus · 2026Article
- Risk Redux? Therapeutic Risk Taking and the Role of Supported Decision Making in Mental Health Settings.International journal of mental health nursing · 2026Article
- Clinical Reasoning Uncertainty in Veterinary Medical Encounters with a Clinical Example.Veterinary sciences · 2025Review
- Article
- Non-clinical factors influencing discharge and admission decisions in the emergency department: a focus group study among Israeli physicians.BMC emergency medicine · 2025Article
- Treatment recommendations based on network meta-analysis: Rules for risk-averse decision-makers.Research synthesis methods · 2025Article
- Navigating uncertainty in patient care: a closer look at emergency medicine residents in Brazil.Frontiers in medicine · 2025Article
- "With Great Responsibility Comes Great Uncertainty".Journal of general internal medicine · 2025Article
- Is emergency doctors' tolerance of clinical uncertainty on a novel measure associated with doctor well-being, healthcare resource use and patient outcomes?Emergency medicine journal : EMJ · 2024Article
- Role of communicating diagnostic uncertainty in the safety-netting process: insights from a vignette study.BMJ quality & safety · 2024Article
- "All of these things interact, that's why it's such a wicked problem": Stakeholders' perspectives of what hinders low back pain care in Australia and how to improve it.Health research policy and systems · 2024Article
- Assessment of mood after severe acquired brain injury: Interviews with UK clinical psychologists and medical professionals.Clinical rehabilitation · 2024Article
- Moving beyond the AI sales pitch - Empowering clinicians to ask the right questions about clinical AI.Future healthcare journal · 2024Article
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRisk aversion among junior doctors that manifests as greater intervention (ordering of tests, diagnostic procedures and so on) has been proposed as one of the possible causes for increased pressure in emergency departments (EDs). Here we tested the prediction that doctors with more experience would be more tolerant of uncertainty and therefore less risk-averse in decision making.
methodsIn this cross-sectional, vignette-based study, doctors working in three EDs were asked to complete a questionnaire measuring experience (length of service in EDs), reactions to uncertainty (Gerrity
resultsData from 90 doctors were analysed. Doctors had worked in the ED for between 5 weeks and 21 years. We found a large association between experience and risk aversion so that more experienced clinicians made less risk-averse decisions (r=0.47, p<0.001). We also found a large association between experience and reactions to uncertainty (r=-0.50, p<0.001), with more experienced doctors being much more at ease with uncertainty. Mediation analyses indicated that tolerance of uncertainty partially mediated the relationship between experience and lower risk aversion, explaining about a quarter of the effect.
conclusionWhile we might be tempted to conclude from this research that experience and the ability to tolerate uncertainty lead to positive outcomes for patients (less risk-averse management strategies and higher levels of safety netting), what we are unable to conclude from this design is that these less risk-averse strategies improve patient safety.
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