Revues

IntroductionDiagnostic uncertainty is ubiquitous in general practice. General practitioners perceive it more frequently duringteleconsultations, where the clinical reasoning process is altered, the physician physician-patient relationship is disrupted, and physica lexamination is limited or absent. In 2020, general practitioners feared that teleconsultations would increase diagnostic unce r-tainty, yet no study had explored how diagnostic uncertainty is managed in this context.ObjectivesTo identify the sources and consequences of diagnostic uncertainty and to explore how general practitioners man-age diagnostic uncertainty in teleconsultations.MethodsAn inductive qualitative study based on semi semi-structured individual interviews was conducted using an interviewguide. Sampling began through networking, then was purposive as interviews progressed until data saturation was reached.Two researchers performed an inductive thematic content analysis.Results: Fifteen interviews approached data saturation. Diagnostic uncertainty was greater in teleconsultations and generatednegative emotional experiences among general practitioners, including worry, frustration, and dissatisfaction. Inappropriateconditions for teleconsultations and difficulties in identifying or interpreting symptoms via video contributed to this uncer tai nty.In response, general practitioners adapted their diagnostic approach by adopting a more exhaustive process, which some-times led to over over- or under under-prescribing and the arrangement in in-person consultations. They also involved patients by explicitlyexpressing their diagnostic uncertainty , instructing them on warning signs, and providing guidance based on symptom evolu-tion.Conclusion: To manage diagnostic uncertainty in teleconsultations, general practitioners modified their usual reasoning pro-cess, tended to over over-prescribe, and arranged in in-person consultations. While the exhaustive diagnostic approach compensatesfor uncertainty, it may also be more resource resource-intensive and less aligned with evidence evidence-based medicine.

Courtin, Marion

physical activity identified in the study was the desire for good mental, physical, and social health¹⁰. Due to its sustainable nature, this program, a pioneer in France since 2015, seemed conducive to studying adherence to an adapted physical activity program.The main objective of the study was to describe the sociodemographic profile of patients benefiting from this program since its creation in 2015. The secondary objective was to compare the profile of patients who received an APA prescription under this program but never attended any session with those who attended multiple sessions.METHOD Study Type and PopulationA retrospective observational study was conducted. The study population consisted of adult patients who consulted at the Aubervilliers CMS and who had received a prescription under the "exercise on prescription" program.The city of Aubervilliers is in Seine-Saint-Denis (93), a department with an over-representation of cardiovascular diseases and social precarity¹¹. The "exercise on prescription" program was created in 2015 at the Aubervilliers CMS in partnership with the municipality. It is free for beneficiaries. Initially, the GP identifies the indication, proposes it to the patient, and prescribes it. The prescribing physicians for APA could be GPs from the CMS and some private GPs in Aubervilliers who were partners in the program. The patient is then registered, and the contact details of the sports educator are provided to them.

The sports educator has validated training as a level 2 health-sport animator from the Île-de-France Regional Olympic and Sports Center. They offer an interview during which they assess the patient's functional abilities, then specify the modalities of the APA sessions, with the possibility of attending one or more weekly sessions, with multiple time slots during the week and several activities (yoga, muscle strengthening, aquagym). The number of sessions is not predetermined and depends on the participant.