Clinical decision-making: coping with uncertainty.

Reliable research and audit information are essential to increasing medical knowledge and improving health service delivery. However there are limits to available information in terms of quality, reliability, and applicability. Furthermore , however much information is gathered, there will always be a degree of uncertainty at the point of making clinical decisions with individual patients. Unrealistic lay and professional expectations of the efficacy of information and that certainty is achievable, may be altering the traditional clinician-patient relationship. One therapeutic role of a clinician is containing the anxieties aroused in the context of uncertainty, and this role may be becoming more difficult. Reliance on protocols and fear of reprimand may lead to clinicians, in some areas of medical care, abandoning their patients at a time of need.