Managing diagnostic uncertainty in primary care: a mixed-methods study of family physicians’ experiences in Türkiye

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Nas M. A., Karahan H., Gürsoy E.

BMC Primary Care, vol.27, no.1, 2026 (SCI-Expanded, Scopus)

  • Publication Type: Article / Article
  • Volume: 27 Issue: 1
  • Publication Date: 2026
  • Doi Number: 10.1186/s12875-026-03196-7
  • Journal Name: BMC Primary Care
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, MEDLINE, Directory of Open Access Journals
  • Keywords: Clinical uncertainty, Decision-making, Family physicians, Mixed-methods, Primary care
  • Open Archive Collection: AVESIS Open Access Collection
  • Erzincan Binali Yildirim University Affiliated: Yes

Abstract

Background: Clinical uncertainty is an inherent component of primary care practice. Family physicians frequently face diagnostic ambiguity, time pressure, and limited access to diagnostic resources, which may affect decision-making and patient outcomes. However, evidence on how family physicians in Türkiye manage diagnostic uncertainty remains limited. Methods: This mixed-methods study included 20 family physicians practicing in primary care settings in Türkiye. Quantitative data were collected using the Physicians’ Reactions to Uncertainty Scale (PRUS) and the Melbourne Decision-Making Questionnaire I-II (MDMQ). Semi-structured interviews were then conducted and analyzed thematically using the Braun and Clarke framework. Results: Quantitative findings showed moderate-to-high emotional reactions to uncertainty and variation in decision-making styles among participants. Thematic analysis of the interviews revealed six key themes: diagnostic challenges and systemic barriers as major sources of uncertainty; specialist consultation, peer support, and patient communication as the main coping strategies; and the significant influence of patient compliance, physicians’ experience, and time pressure on decision-making. High patient load, referral difficulties, and inadequate digital systems were identified as major health system challenges. Physicians consistently emphasized the importance of case-based training and professional development, while also highlighting the role of transparent physician–patient communication in reducing uncertainty. Conclusions: Diagnostic uncertainty is a multifaceted challenge in primary care in Türkiye, influenced by individual, systemic, and patient-related factors. Strengthening case-based educational programs, improving referral processes, and reducing patient load may enhance physicians’ ability to manage uncertainty and improve patient outcomes. Clinical trial number: Not applicable.