Clinical Uncertainty in Primary Care [recurso electrónico] The Challenge of Collaborative Engagement

**The Power of Colleagues** **What happens when primary care clinicians****meet together on set aside time in their practice settings to talk about their own patients?** .....Complimenting quality metrics or performance measures through discussing the actual stories of individual patients and their clinician-patient relationships **In these settings, how can clinicians pool their collective experience** **and apply that to ‘the evidence’ for an individual patient?** **.....**Especially for patients who do not fit the standard protocols and have vague and worrisome symptoms, poor response to treatment, unpredictable disease courses, and/or compromised abilities for shared decision making **What follows when discussion about individual patients reveals system-wide service gaps and coordination limitations?** .....Particularly for patients with complex clinical problems that fall outside performance monitors and quality screens **How can collaborative engagement of case-based uncertainties with one’s colleagues help combat the loneliness and helplessness that PCPs can experience, no matter what model or setting in which they** **practice?** .....And where they are expected to practice coordinated, evidence-based, EMR-directed care These questions inspired Lucia Sommers and John Launer and their international contributors to explore the **power of colleagues** in **“Clinical Uncertainty in Primary Care: The Challenge of Collaborative Engagement”** and offer antidotes to sub-optimal care that can result when clinicians go it alone. From the Foreword: “Lucia Sommers and John Launer, with the accompanying input of their contributing authors, have done a deeply insightful and close-to-exhaustive job of defining clinical uncertainty. They identify its origins, components and subtypes; demonstrate the ways in which and the extent to which it is intrinsic to medicine...and they present a cogent case for its special relationship to primary care practice...‘Clinical Uncertainty in Primary Care’ not only presents a model of collegial collaboration and support, it also implicitly legitimates it.’’ Renee Fox, Annenberg Professor Emerita of the Social Sciences, University of Pennsylvania. "This is a book about primary care clinicians and the clinical uncertainty endemic to their work. Even when seemingly straightforward, each patient raises unique questions regarding how best to listen to their complaints, empathize with their suffering, or respond to their silences. This book is also about addressing uncertainty in primary care practice and engaging it. Engagement requires knowledge, explicit and tacit, placed in the service of a single patient's problem. It also requires carefully managed communication, facilitating dialogue with the patient and encouraging shared problem-solving. Most importantly, this book is about collaborative engagement with case-based uncertainty in the setting of small groups of clinicians. Sommers and Launer contend that the medical profession's tradition of working independently should be augmented with an explicitly shared, collegial one of jointly creating wisdom through practice-based learning. An international panel of expert clinicians and educators provides: Perspectives on clinical uncertainty in the medical literature A taxonomy of clinical uncertainty with patient examples Analysis of the educator role to support clinicians in engaginguncertainty A compendium of small group methods for collaborative engagement with clinical scenarios Analysis of the special challenges ofcollaborative engagement A mind-opening manifesto, Clinical Uncertainty in Primary Care will equip primary care clinicians, educators, public health and behavioral health professionals with resources for infusing practice with meaning through collegial collaboration. From the Foreword: 'Lucia Sommers and John Launer, with the accompanying inputof their contributing authors, have done a deeply insightful and close to exhaustive job of defining clinical uncertainty. They identify its origins, components, and subtypes; demonstrate the ways in which and the extent to which it is intrinsic to medicine ... and present a cogent case for its special relationship to primary care practice ... Clinical Uncertainty in Primary Care not only presents a model of collegial collaboration and support, it also implicitly legitimates it.' Renee Fox, Annenberg Professor Emerita of the Social Sciences, University of Pennsylvania“ – Font no determinada This is a book about primary care clinicians and the clinical uncertainty endemic to their work. Even when seemingly straightforward, each patient raises unique questions regarding how best to listen to their complaints, empathize with their suffering, or respond to their silences. This book is also about addressing uncertainty in primary care practice and engaging it. Engagement requires knowledge, explicit and tacit, placed in the service of a single patient's problem. It also requires carefully managed communication, facilitating dialogue with the patient and encouraging shared problem-solving. Most importantly, this book is about collaborative engagement with case-based uncertainty in the setting of small groups of clinicians. Sommers and Launer contend that the medical profession's tradition of working independently should be augmented with an explicitly shared, collegial one of jointly creating wisdom through practice-based learning. An international panel of expert clinicians and educators provides: Perspectives on clinical uncertainty in the medical literature A taxonomy of clinical uncertainty with patient examples Analysis of the educator role to support clinicians in engaging uncertainty A compendium of small group methods for collaborative engagement with clinical scenarios Analysis of the special challenges of collaborative engagement A mind-opening manifesto, Clinical Uncertainty in Primary Care will equip primary care clinicians, educators, public health and behavioral health professionals with resources for infusing practice with meaning through collegial collaboration. From the Foreword: "Lucia Sommers and John Launer, with the accompanying inputof their contributing authors, have done a deeply insightful and close to exhaustive job of defining clinical uncertainty. They identify its origins, components, and subtypes; demonstrate the ways in which and the extent to which it is intrinsic to medicine...and present a cogent case for its special relationship to primary care practice...Clinical Uncertainty in Primary Care not only presents a model of collegial collaboration and support, it also implicitly legitimates it." Renee Fox, Annenberg Professor Emerita of the Social Sciences, University of Pennsylvania This is a book about primary care clinicians and the clinical uncertainty endemic to their work. Even when seemingly straightforward, each patient raises unique questions regarding how best to listen to their complaints, empathize with their suffering, or respond to their silences. This book is also about addressing uncertainty in primary care practice and engaging it. Engagement requires knowledge, explicit and tacit, placed in the service of a single patients problem. It also requires carefully managed communication, facilitating dialogue with the patient and encouraging shared problem-solving. Most importantly, this book is about collaborative engagement with case-based uncertainty in the setting of small groups of clinicians. Sommers and Launer contend that the medical professions tradition of working independently should be augmented with an explicitly shared, collegial one of jointly creating wisdom through practice-based learning. An international panel of expert clinicians and educators provides: Perspectives on clinical uncertainty in the medical literature A taxonomy of clinical uncertainty with patient examples Analysis of the educator role to support clinicians in engaging uncertainty A compendium of small group methods for collaborative engagement with clinical scenarios Analysis of the special challenges of collaborative engagement A mind-opening manifesto, Clinical Uncertainty in Primary Care will equip primary care clinicians, educators, public health and behavioral health professionals with resources for infusing practice with meaning through collegial collaboration. From the Foreword: "Lucia Sommers and John Launer, with the accompanying inputof their contributing authors, have done a deeply insightful and close to exhaustive job of defining clinical uncertainty. They identify its origins, components, and subtypes; demonstrate the ways in which and the extent to which it is intrinsic to medicine...and present a cogent cas e for its special relationship to primary care practice...Clinical Uncertainty in Primary Care not only presents a model of collegial collaboration and support, it also implicitly legitimates it." Renee Fox, Annenberg Professor Emerita of the Social Sciences, University of Pennsylvania The Power of Colleagues What happens when primary care clinicians meet together on set aside time in their practice settings to talk about their own patients? .....Complimenting quality metrics or performance measures through discussing the actual stories of individual patients and their clinician-patient relationships In these settings, how can clinicians pool their collective experience and apply that to 'the evidence' for an individual patient? ..... Especially for patients who do not fit the standard protocols and have vague and worrisome symptoms, poor response to treatment, unpredictable disease courses, and/or compromised abilities for shared decision making What follows when discussion about individual patients reveals system-wide service gaps and coordination limitations? .....Particularly for patients with complex clinical problems that fall outside performance monitors and quality screens How can collaborative engagement of case-based uncertainties with one's colleagues help combat the loneliness and helplessness that PCPs can experience, no matter what model or setting in which they practice? .....And where they are expected to practice coordinated, evidence-based, EMR-directed care These questions inspired Lucia Sommers and John Launer and their international contributors to explore the power of colleagues in "Clinical Uncertainty in Primary Care: The Challenge of Collaborative Engagement" and offer antidotes to sub-optimal care that can result when clinicians go it alone. From the Foreword: "Lucia Sommers and John Launer, with the accompanying input of their contributing authors, have done a deeply insightful and close-to-exhaustive job of defining clinical uncertainty. They identify its origins, components and subtypes; demonstrate the ways in which and the extent to which it is intrinsic to medicine...and they present a cogent case for its special relationship to primary care practice...'Clinical Uncertainty in Primary Care' not only presents a model of collegial collaboration and support, it also implicitly legitimates it.'' Renee Fox, Annenberg Professor Emerita of the Social Sciences, University of Pennsylvania. Front Matter....Pages i-xiv Front Matter....Pages 1-1 Introduction....Pages 3-21 Uncertainty and Clinical Method....Pages 23-45 Learning About Uncertainty in Professional Practice....Pages 47-69 Front Matter....Pages 71-71 Balint Groups and Peer Supervision....Pages 73-93 Research on Balint Groups....Pages 95-116 The Thistle and the Maple Leaf: Practice-Based Small-Group Learning in Canada and Scotland....Pages 117-146 Narrative-Based Supervision....Pages 147-161 Training in Narrative-Based Supervision: Conversations Inviting Change....Pages 163-176 Practice Inquiry: Uncertainty Learning in Primary Care Practice....Pages 177-215 Using Practice Inquiry to Engage Uncertainty in Residency Education....Pages 217-239 “We’re All in the Same Boat:” Potentials and Tensions When Learning Through Sharing Uncertainty in Peer Supervision Groups....Pages 241-269 Case-Based Learning in Swedish Primary Health Care: Strengths and Challenges....Pages 271-291 Afterword....Pages 293-302 Back Matter....Pages 303-306 This book surveys clinical uncertainty in primary care and primary care education, offering definitions, research on effects, methods for dealing with uncertainty and details of the practice inquiry process as it is applied in a variety of clinical settings.