“We Aren’t Here to Win; We are Here Not to Lose”: Emergency Physicians’ Communicative Management of Uncertainty

ABSTRACT

Healthcare providers in hospital emergency departments (EDs) work under high uncertainty and pressure to manage a variety of patients efficiently. Whereas much existing research has examined communicative implications of uncertainty from patients’ perspectives, we explored ED physicians’ experiences of uncertainty in their everyday work environment. Through an ethnographic fieldwork in an ED, we identified three main sources of uncertainty routinely faced by physicians: (a) patients’ incorrect expectation about the role of ED; (b); patient variability and ED physicians’ breadth of expertise; and (c) emerging and unexpected changes in patient cases after handoffs. We also found how ED physicians managed these uncertainties, including: (1) direct admission of scientific uncertainty to patients; (2) lowering epistemic uncertainty through swift Internet searches; and (3) maintenance of situational uncertainty. We discuss implications of these findings for researchers, providers, and hospital organizations.

Disclosure statement

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

Notes

1. To develop rapport and familiarity with the ED physicians, we (a) shared our background and research interests; (b) were respectful and accommodating of their needs (e.g., not asking when they are focused on charting); (c) showed genuine interest in their work and decisions; and (d) were honest and sympathetic in challenging situations (e.g., commenting, “This [dealing with screaming patients] must be frustrating when you are trying to do what’s best for them” which gave the physician an opportunity to vent). Through these efforts, we began noticing the physicians becoming more comfortable with our presence and open with us. For example, they would ask us to join them during a break time or eat snacks with them, and ask us casual and candid questions such as “Did you see how this patient was telling a totally different story than what his brother said earlier? I am not wrong, right?”

2. When ED patients report specialty-related concerns (e.g., cardiological or neurological), emergency physicians contact specialist physicians in a relevant department of the hospital – sometimes more than one – by sharing their assessment and why the specialist’s attention seems needed, based on their broad knowledge of illnesses. Specialists then provide in-depth expertise to run diagnostic tests for a defined group of illnesses and interpret results. This process requires a complex and often challenging coordination among the involved units (see Kim et al., 2018). For instance, if specialists are unavailable to see the patient immediately, emergency physicians may provide temporary remedies for patients (e.g., pain medication) as they are not equipped to manage specialty-related tests or decisions.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.