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

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 Turkiye manage diagnostic uncertainty remains limited. Methods This mixed-methods study included 20 family physicians practicing in primary care settings in Turkiye. 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 Turkiye, 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.

Journal

BMC PRIMARY CARE

Year

2026

Volume

27

Issue

1

eISSN

2731-4553

DOI

10.1186/s12875-026-03196-7

WoS UID

WOS:001694899300001