Embracing Uncertainty in Medicine


snowball-book cover

Dr. Steven Hatch is an infectious disease and immunology specialist who has written an important book on the nature of uncertainty in medicine.  There are times when doctors should say “I don’t know”, and this is underscored in Hatch’s interview in Atlantic magazine — a must read if you don’t have a chance to read his book.

Here’s the thing, though.  Patients rarely want to hear “I don’t know” or “I’m not sure” from their doctors.  I recall a time earlier in my career when I would hold a conference with a patient or family members to review my findings.  I felt that it was not my job to be paternalistic and dictate what to do, but to indicate what we found, and provide options.  For example, a lens or prism Rx with or without undertaking optomteric vision therapy.

A troubling pattern began to emerge.  The more options presented to the patient, the less likelihood there was that they would follow through on what I felt to be the best treatment plan.  When my staff would follow up with a patient on proceeding with treatment, it was not uncommon to learn that the patient felt that I wasn’t confident that treatment could be of benefit.  The patient was misperceiving my openness in presenting different ways of looking at the data and circumstances as hesitancy or uncertainty on my part, rather than the inherent fuzziness in test results and data.

Irrespective of one’s field, this “fuzziness” is the challenge that Hatch probes: attaining the balance between being overconfident or over-promising, yet arriving at a definitive conclusion that enables care to be appropriately perceived as essential.  As healthcare becomes more commoditized, it is also the challenge between being perceived as a sales person as opposed to being valued as an empathic professional.  Nor are these distinctions absolute.  There are some patients who crave data and welcome studies to peruse.  There are others who need simple reassurance that treatment is indicated and, when rendered, reassurance that treatment is progressing well.  How to make these distinctions, and provide what individual patients need in an empathic way, is the art of practice that takes years to master.

 

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