The Clinical Reasoning Series – Navigating uncertainty with Dr Nathalia Costa

The Words Matter Podcast with Oliver Thomson

Welcome to another episode of The Words Matter Podcast.

So we are up to the 8th episode of the Clinical Reasoning Series and on today I’m speaking with Dr Nathalia Costa about clinical uncertainty. Nathalia is a Brazilian physiotherapist who completed PhD studies in Australia used mixed-methods to investigate the nature of low back pain flares (see here). This PhD work was won the Lumbar Spine Research Prize awarded by the Society for Study of the Lumbar Spine in 2021 (see Nathalia's other research here).

Nathalia is currently working as a Postdoctoral Research Fellow at the Universities of Queensland (UQ) and Sydney (USyd) investigating how both clinicians and people with low back pain navigate uncertainty during clinical encounters. And as such we speak about her work investigating uncertainty and talk around a paper, she and her colleagues published this year titled 'Uncertainty in low back pain care – insights from an ethnographic study', published in the journal Disability and Rehabilitation (see paper here) and a previous podcast on ethnography here with Dr Fiona Webster here).

So on this episode we speak about:

• What uncertainty is and allude to the different ways and taxonomies used to describe it.
• Different sources of uncertainty and use the ambiguous nature of low back pain as an exemplar.
• The ways that we as clinicians might neglect uncertainty or attend to it.
• How we often seek to reduce uncertainty through the use of clinical reasoning or the application of evidence for examples through clinical guidelines.
• We talk about how an intolerance to uncertainty may prompt binary thinking and cause us to retreat to the comfort of the biomedical model and biomedical thinking.
• Occasions when we really do want to be certain as we can possibly be, and that there may be some ethical and therapeutic merit in communicating this to our patients.
• How uncertainty with low back pain is imbued with emotions – on both patient and clinician’s part.
• How clinicians may emphasise uncertainty to patients, intentionally or unintentionally and the resulting impact that this might have on the balance of power within the relationship
• And we reflect on ways that clinicians better navigate uncertainty.

So this was another brilliant conversation. Uncertainty, whether we like it or not surrounds and often defines our clinical work and is the omnipresent elephant in the clinical room and lives of our patients. Nathalia’s work provides some crucial insights into the slippery and uncomfortable nature of clinical uncertainty which can allow us to reflect on how it make us and our patients feel and consider how we react in the face of it.

As always, I have linked Nathalia's paper in the show notes, but please look out for a follow up paper which adopts a theory-driven post-qualitative approach to explore clinicians’ experiences navigating uncertainty when working with patients with low back pain (see podcasts here on post-qualitative research here and here).

Find Nathalia on Twitter @nathaliaccosta1

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Find Nathalia on Twitter @nathaliaccosta1

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