5 - Uncertainty in Medicine: Leaps of Faith
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What is the central theme of “Uncertainty in Medicine: Leaps of Faith”?
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John Brush is a cardiologist who spent years in the cocoon of academic medicine, medical school, residency, rounding with teams, a fellowship at the NIH, teaching at Boston University. When he made the shift to private practice, he thought he was prepared.
One of the things that just sort of struck me first when you go from pr from academics to private practice is first of all you're working totally alone. You can't lean on other people. You have to deal with the uncertainty by yourself. In private practice, you're a kind of a lone ranger out there, whereas before you were surrounded by people and and dealing with it and discussing it and what have you, and it sort of softened the edge of uncertainty. But when you're in private practice alone, say seeing a patient in the middle of the night by yourself in an emergency room trying to sort out what in the heck's going on, uncertainty sort of hits you like a t ton of bricks.
No one had prepared him for what it would feel like to be out in the wild. In the academic setting, he was surrounded by experts, talking through cases, weighing options together, operating in a system that gave the illusion of control. But now in private practice, uncertainty wasn't just an academic subject to analyze and debate. It was something to survive.
There's an enormous amount of uncertainty in Madison. Enormous amount, you just don't know.
And that weight, the burden of facing down the unknown alone. Sent him searching.
I started reading in the literature about uncertainty and cognitive science and probability and logic and All of that just trying to sort out how people deal with uncertainty.
He didn't find clarity, but he did find something stranger. Something akin to faith.
I was just starting to think about the fact that you know we make bets all day long. I'm betting on the fact that this person is having this diagnosis or that diagnosis. I'm betting on the fact that you know, giving this prescription versus not giving this prescription is gonna make this patient better, not worse. You're betting all the time. We deal with the uncertainty b by making bets. We we deal with probability. Probability is uncertainty quantified. There are too many missing pieces to most of the problems, and so you can't logically build it like an engineer builds a bridge. You gotta make some jumps and you gotta you know, you gotta make some estimates and you gotta make some assumptions and You know, the whole point of it.
The whole point of all of this. is uncertainty.
And that was the revelation. That medicine isn't about mastering uncertainty, it's about learning how to move forward in it. How to have the courage to jump when you don't know where you'll land. This is the Nocturnus, Uncertainty in Medicine. I'm Emily Silverman. Today we have three stories of people who learned how to move forward through uncertainty. By choosing to act, choosing not to act, or having no choice at all. In the fog of not knowing, each finds a way to take the next step.
Mm-hmm.
Two patients arrive on Dan Donahoe's docket, both with the very same type of specific brain tumor called a glioma.
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Chapters
3 chapters
1
What is the central theme of “Uncertainty in Medicine: Leaps of Faith”?
0:00–13:02
2
How does the episode introduce the concept of uncertainty and “betting” in clinical decisions?
13:02–24:13
3
What ethical dilemmas does the pediatric neurosurgeon face when treating glioma in children?
24:13–27:56