Management of diagnostic uncertainty in teleconsultation by General Practitioners (GPs) in primary care

Marion Courtin ⁽¹⁾, Hadrien Prelaud ⁽¹⁾, William Mirat ⁽¹⁾, Julien Le Breton ⁽¹⁾, Florian Caselli ⁽¹⁾

Management of diagnostic uncertainty in teleconsultation by General Practitioners (GPs) in primary care

Marion Courtin ⁽¹⁾, Hadrien Prelaud ⁽¹⁾, William Mirat ⁽¹⁾, Julien Le Breton ⁽¹⁾, Florian Caselli ⁽¹⁾

(1) Université Paris-Est Créteil Val-de-Marne - Faculté de médecine

Abstract

IntroductionDiagnostic uncertainty is ubiquitous in general practice. General practitioners perceive it more frequently duringteleconsultations, where the clinical reasoning process is altered, the physician physician-patient relationship is disrupted, and physica lexamination is limited or absent. In 2020, general practitioners feared that teleconsultations would increase diagnostic unce r-tainty, yet no study had explored how diagnostic uncertainty is managed in this context.ObjectivesTo identify the sources and consequences of diagnostic uncertainty and to explore how general practitioners man-age diagnostic uncertainty in teleconsultations.MethodsAn inductive qualitative study based on semi semi-structured individual interviews was conducted using an interviewguide. Sampling began through networking, then was purposive as interviews progressed until data saturation was reached.Two researchers performed an inductive thematic content analysis.Results: Fifteen interviews approached data saturation. Diagnostic uncertainty was greater in teleconsultations and generatednegative emotional experiences among general practitioners, including worry, frustration, and dissatisfaction. Inappropriateconditions for teleconsultations and difficulties in identifying or interpreting symptoms via video contributed to this uncer tai nty.In response, general practitioners adapted their diagnostic approach by adopting a more exhaustive process, which some-times led to over over- or under under-prescribing and the arrangement in in-person consultations. They also involved patients by explicitlyexpressing their diagnostic uncertainty , instructing them on warning signs, and providing guidance based on symptom evolu-tion.Conclusion: To manage diagnostic uncertainty in teleconsultations, general practitioners modified their usual reasoning pro-cess, tended to over over-prescribe, and arranged in in-person consultations. While the exhaustive diagnostic approach compensatesfor uncertainty, it may also be more resource resource-intensive and less aligned with evidence evidence-based medicine.

Keywords

• [SDV]Life Sciences [q-bio]
• [SHS]Humanities and Social Sciences
• Uncertainty
• Qualitative research
• Primary care
• Remote consultation

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