• accreditation
• attitudes
• audit and feedback

Picture yourself in a casino sitting at the roulette table. Will you put your money on either black or red, or will you go for a riskier choice and place it on just a single number? But before you can make up your mind, the elderly, obese smoker to your right reaches for his chest and collapses. ‘What is wrong with him?’, cries his accompanying wife, looking at you in shock.

In this issue, Lawton and colleagues ask whether more experienced clinicians are better able to tolerate uncertainty and manage risks.1 Doctors working in three emergency departments (ED) read four clinical vignettes each accompanied by four quite distinct options for management, all of which might be deemed clinically acceptable. Participants used 5-point Likert scales to indicate their agreement with each of the management plans. By design, the four options offered for each vignette included two management plans one would characterise as ‘risk averse’—requiring further tests and/or admission of the patient to hospital. The other two management plans may be seen as less risk averse, usually involving referring a patient back to the general practitioner or offering reassurance to the patient. In addition to rating their agreement with each of the possible management plans for the four vignettes, participants reported their experience (number of years worked in an ED setting) and answered a 15-item ‘Physicians Reactions to Uncertainty’ scale. Analysing the responses from 90 doctors, who had worked in EDs for between 5 weeks and 21 years, Lawton and colleagues report a medium to large correlation between experience and tolerance of risk. More experienced clinicians made less risk averse decisions.

We would like to provide three conceptual considerations potentially relevant to interpret these results from Lawton and colleagues and identify possible follow-up research.