Nas, Mehmet Akif; Karahan, Harun; Gürsoy, Ersan

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.

Vatansever, Mehmet; Gürsoy, Ersan; Hayme, Serhat

Background: This study aimed to evaluate the hemoglobin, albumin, lymphocyte, and platelet (HALP) score as an exploratory adjunctive marker associated with reduced bone density, particularly in resource-limited settings. Methods: This cross-sectional study was conducted between October 2022 and October 2023 at the Physical Therapy and Rehabilitation Hospital in Trabzon, Türkiye. This study included 267 patients who had not been previously diagnosed with osteopenia or osteoporosis and had undergone a dual-energy X-ray absorptiometry (DEXA) scan within the previous year. The participants were categorized into the normal, osteopenic, and osteoporotic groups according to their DEXA results. Statistical analysis included receiver operating characteristic (ROC) curve assessment, sensitivity and specificity calculations, and multiple logistic regression analysis to evaluate the discriminative performance of the HALP score and its adjusted association with reduced bone density. Results: Patients with reduced bone density (osteopenia or osteoporosis) had substantially lower HALP scores than those with a normal bone density. The area under the curve (AUC) for the HALP score was 0.625, indicating a limited discriminative ability. The HALP score exhibited a sensitivity of 65.36% and a specificity of 55.26% for identifying reduced bone density. In multivariable analysis, higher HALP remained associated with lower odds of osteopenia/osteoporosis after adjustment (OR = 0.757, 95% CI 0.624–0.917, p = 0.004). Conclusion: Given its limited discriminative ability, HALP should not be interpreted as a stand-alone screening test. At most, it may represent a low-cost exploratory adjunctive signal that could help support consideration of confirmatory DEXA in resource-limited settings, pending external validation. Trial registration: Not applicable.