Uncertainty in low back pain care – insights from an ethnographic study

Abstract

Purpose

To explore how uncertainty plays out in low back pain (LBP) care and investigate how clinicians manage accompanying emotions/tensions.

Materials and methods

We conducted ethnographic observations of clinical encounters in a private physiotherapy practice and a public multidisciplinary pain clinic. Our qualitative reflexive thematic analysis involved abductive thematic principles informed by Fox and Katz (medical uncertainty) and Ahmed (emotions).

Results

We identified three themes. (1) Sources of uncertainty: both patients and clinicians expressed uncertainty during clinical encounters (e.g., causes of LBP, mismatch between imaging findings and presentation). Such uncertainty was often accompanied by emotions – anger, tiredness, frustration. (2) Neglecting complexity: clinicians often attempted to decrease uncertainty and associated emotions by providing narrow answers to questions about LBP. At times, clinicians’ denial of uncertainty also appeared to deny patients the right to make informed decisions about treatments. (3) Attending to uncertainty?: clinicians attended to uncertainty through logical reasoning, reassurance, acknowledgement, personalising care, shifting power, adjusting language and disclosing risks.

Conclusions

Uncertainty pervades LBP care and is often accompanied by emotions, emphasising the need for a healthcare culture that recognises the emotional dimensions of patient-clinician interactions and prepares clinicians and patients to be more accepting of, and clearly communicate about, uncertainty.

IMPLICATIONS FOR REHABILITATION

• Uncertainty pervades LBP care and is often accompanied by emotions.

• Neglecting complexity in LBP care may compromise person-centred care.

• Acknowledging uncertainty can enhance communication, balance patient-clinician relationships and address human aspects of care.

Keywords:

• Low back pain
• uncertainty
• emotions
• qualitative research
• person-centred care

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Acknowledgements

We thank Leonardo Digiorgio, Tharuka Prematillake and Mary-Anne Patton for conducting the ethnographic observations and writing the field notes. We also thank all the patients and clinicians for their willingness to be observed and participate in the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This project received funding from an Arthritis Australia (Project Grant), and The University of Queensland (Early Career Research Grant). JS and PH are supported by National Health and Medical Research of Australia [NHMRC, JS: APP1157199 and PH: APP1102905].