TY - JOUR T1 - Embracing uncertainty to advance diagnosis in general practice JF - British Journal of General Practice JO - Br J Gen Pract SP - 244 LP - 245 DO - 10.3399/bjgp17X690941 VL - 67 IS - 659 AU - Kirsti Malterud AU - Ann Dorrit Guassora AU - Susanne Reventlow AU - Annemarie Jutel Y1 - 2017/06/01 UR - http://bjgp.org/content/67/659/244.abstract N2 - In general practice, an accurate and rapid diagnosis could be obvious (herpes zoster), or essential (sepsis). More often, however, diagnosis in general practice is characterised by uncertainty. This may be because time is necessary for a particular condition to declare itself, or alternatively, that the problem will be self-limiting. The picture may be clouded by multimorbidity, as well as by culturally-shaped perceptions, interpretations, and presentations of symptoms.1 We argue, however, that diagnostic uncertainty is not, as Jones has suggested, the new Achilles’ heel of general practice, to avoid at all cost.2We maintain instead that uncertainty typifies the nature and complexity of clinical knowledge, and is particularly salient in general practice.3 Diagnostic uncertainty deserves attention; not as evidence of sloppy practice, or professional failure, but as an inherent feature of, and condition for, advanced medical diagnosis. The nature of clinical knowledge rests on interpretation and judgment of bits and pieces of information which will always be partial and situated.4 In this commentary, we argue that the quality of diagnosis in general practice is compromised by believing that uncertainty can, and should, be eliminated.On the contrary, we suggest, appropriate management of intrinsic uncertainty is a core clinical skill, which cannot be obtained from an essentialist attitude to knowledge where certainty is taken for granted as the standard. Only by embracing uncertainty as a predictable and inevitable companion of general practice,5 will the GP be able to … ER -