Clinical Uncertainty in Primary Care

Lucia Siegel Sommers is an educator and health services researcher with a 40-year history of working with clinician small groups. She holds an undergraduate degree from the University of Pennsylvania; a masters in social work from Bryn Mawr University; a doctorate in public health from the University of California, Berkeley and completed a 2-year fellowship in health services research at Stanford University. From 1994 through 2001, Lucia was a full-time faculty member in the Internal Medicine Residency Program at St. Mary’s Medical Center in San Francisco and Associate Program Director from 1997 to 2001. She is currently an assistant professor in the Department of Family and Community Medicine at the University of California San Francisco where she has taught medical students since 1996. Her published research includes studies focused on the effectiveness of medical audit, nurse-physician collaboration to improve care and reduce costs in hospitals and interdisciplinary care for thefrail elderly in the primary care office setting.John Launer is a family physician, family therapist, educator and writer. He graduated in English at Cambridge before studying medicine at London University. After obtaining Membership of the Royal College of General Practitioners with distinction in 1983, he worked for 22 years as a GP in Edmonton, north London, and continues to work as a part-time GP. In 1994 he completed training at the Tavistock Clinic as a family therapist and joined the senior staff there as honorary consultant in general practice and primary care. Since then his teaching and clinical work has drawn together ideas from family medicine and family therapy, with a focus on narrative and clinical supervision. John is an Associate Dean for Postgraduate Medical Education at London University, and has published five previous books as author or editor, including ‘Narrative-Based Primary Care: A Practical Guide.’ He has lectured and run workshops internationally, including in the USA, Canada, Scandinavia, Israel and Japan.

"This book is helpful reading for family physicians and essential for its teachers; it addresses a ubiquitious problem that we too often avoid as being too complex for discussion ... . The book helps us speak honestly about an essential truth concerning primary care-that much of what we do is not exact science, cannot be taught as technique, and won't be clarified through yet one more evidence-based guideline or clinic workflow ... ." (John Muench, Family Medicine, stfm.org, July-August, 2016)

• Section One: Clinical Uncertainty in Primary Care1.Introduction.- 2.Uncertainty and Clinical Method.- 3.Learning about Uncertainty in Professional Practice.- Section Two: The Challenge of Engagement.- 4.Balint Groups and Peer Supervision.- 5.Research on Balint groups.- 6.The Thistle and the Maple Leaf: PBSGL in Canada and Scotland.- 7.Narrative-Based Supervision.- 8.Training in Narrative-based supervision: Conversations inviting change.- 9.Practice Inquiry: Uncertainty Learning in Primary Care Practice.- 10.Using Practice Inquiry to Engage Uncertainty in Residency Education.- 11.“We’re all in the same boat”: Potentials and Tensions When Learning Through Sharing Uncertainty in Peer Supervision Groups.- 12.Case-Based Learning in Swedish Primary Health Care: Strengths and Challenges.- 13. Afterword.