Medical uncertainty

Medicine is in many ways a black art. It is not a science; it is an art guided by science. The guidance the science offers varies considerably from, for example, bone surgery to psychiatry, but the uncertainty is always there, even in the high-tech surroundings of the PICU. Our complicated machinery can mask the fact we occasionally are unsure about what we are doing and why. Sometimes we have almost no idea what is going on with our patients, a circumstance some doctors have trouble admitting both to themselves and to patients’ families. It is a difficult thing, at least the first few times you do it, to talk to a family when much of what you say describes your ignorance. With practice, though, it gets easier, especially when you know — really, truly know — that you can always do something to make a sick child more comfortable.

 If you want to read more about an in-the-trenches account of how physicians deal with uncertainties, I suggest Atul Gawande’s book Complications (Picador, 2002).


2 responses to “Medical uncertainty”

  1. It’s refreshing to hear a lab-coat-wearer admit to ignorance and uncertainty. My doctor has trouble with that occasionally and I have to remind him it’s okay to shrug now and then.

    What, like I’m supposed to know everything about participles and case just because I write?

    I’ll bet your patients and their parents are grateful for your honesty, much as they might hope for omniscience.

  2. You’re right, Frank — part of the problem is not patients’ expectations of doctors but doctor’s unrealistic expectations of ourselves. We’re the products of a training system that rewards the fledgling doctor for having an answer (preferably the right one, but an answer nonetheless) and punishes not having an answer.

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