چکیده (انگلیسی):

Background:Uncertainty is inevitable in clinical practice in primary care and tolerance for uncertainty and concern
for bad outcomes has been shown to vary between physicians. Uncertainty is a factor for inappropriate antibiotic
prescribing. Evidence-based guidelines as well as near-patient tests are suggested tools to decrease uncertainty in
the management of patients with respiratory tract infections. The aim of this paper was to describe strategies for
coping with uncertainty in patients with pharyngotonsillitis in relation to guidelines.
Methods:An interview study was conducted among a strategic sample of 25 general practitioners (GPs).
Results:All GPs mentioned potential dangerous differential diagnoses and complications. Four strategies for coping
with uncertainty were identified, one of which was compliant with guidelines,“Adherence to guidelines”, and three
were idiosyncratic:“Clinical picture and C-reactive protein (CRP)”, “Expanded control”, and “Unstructured”. The
residual uncertainty differed for the different strategies: in the strategy “Adherence to guidelines” and“Clinical
picture and CRP” uncertainty was avoided, based either on adherence to guidelines or on the clinical picture and
near-patient CRP; in the strategy“Expanded control” uncertainty was balanced based on expanded control; and in
the strategy“Unstructured” uncertainty prevailed in spite of redundant examination and anamnesis.
Conclusion:The majority of the GPs avoided uncertainty and deemed they had no problems. Their strategies
either adhered to guidelines or comprised excessive use of tests. Thus use of guidelines as well as use of more
near-patient tests seemed associated to reduced uncertainty, although the later strategy at the expense of
compliance to guidelines. A few GPs did not manageto cope with uncertainty or had to put in excessive
work to control uncertainty.