Undifferentiated presentations & uncertainty

Uncertainty and undifferentiated presentations

There are many consultations where there are no straight answers, no clear diagnosis and no obvious treatment, where guidelines and decision-making protocols do not lead to a satisfactory outcome. Without strategies to address uncertainty (such as safety-netting and discussing with peers) it can become a source of stress to GPs. The concept of uncertainty links closely with the Medically Unexplained Symptoms lectures as discussed in Year 3 Term 3 central teaching. 

"If there is one certainty in general practice, it is the inherent presence of uncertainty."

Undifferentiated presentations 

- a patient comes in to be diagnosed for the first time: are very common in primary care and a firm diagnosis is elusive in many encounters. Symptoms are often vague, examination findings unclear, investigation results conflicting, and response to treatment inconsistent. Guidelines may be irrelevant or non-existent. Clinical decision-making may be compromised for a myriad of reasons. As a result, uncertainty is intrinsic to the general practice encounter. Indeed, it has even been proposed that managing uncertainty is the ‘specialty’ of general practice

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