BONUS - Managing Uncertainty: A Path to Better Patient Care
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What word do listeners associate with uncertainty in medicine and why?
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Hey everyone, it's Emily. As you may know, we wrapped our uncertainty series last week, but this week, we've got a bonus episode for you. It features me and our uncertainty correspondent from the series, Alexa Miller. A few weeks ago, the ABIM Foundation invited me and Alexa to do a webinar where we shared some reflections on the series, and it turned into a really thoughtful conversation. So give it a listen. We hope you enjoy it.
To start us off, I'd like to ask everyone in the audience if you could please put a put one word in your chat that comes to mind when you think about uncertainty in medicine. So Emily and Alexa, when you see these words, what comes to mind um what comes to mind for you? I mean, I want to say first of all, my word is angst. Um, but what comes to mind for you and maybe you can each share a moment, big or small, um, when uncertainty in medicine really um came to life for you. So stressed, I see anxiety, I see concern, hesitancy. Let me start with you, Emily.
Yes, so I'm definitely seeing a lot of those words angst, stress, anxiety, concern, and that's super normal and super common. And I share those feelings. Um there's a lot of uh angst, I guess you could say, when it comes to sitting in uncertainty. One of the things that I learned in working with Alexa and reviewing a lot of the uncertainty Literature and scholarship is that even though there's a lot of negatively valenced emotions associated with uncertainty, there can also be positively valenced emotions associated with it. And that was eye-opening for me because it really helped me shift and reframe the way I think about it. So for example, if you're reading a detective novel and you don't know what's gonna happen next, there's a sort of um excitement that you might feel.
Or if you're a patient in a clinical trial and you don't know if you're on the placebo arm or the treatment arm. And even if you are on the treatment arm, you don't know if the treatment works. But in the absence of other treatment options, just being inside that cloud of uncertainty can offer a lot of people feelings of hope. And so um I think there's no good or wrong um response to uncertainty, but there's a huge diversity of responses and um I think it's very quick to just go right to the negative because that's so in our experience. But for me it was really illuminating to remember, you know, that intellectual stimulation and excitement and mystery and wonder and hope and there's that whole other facet.
Of it. So yeah. Maybe I'll kick it to you, Alexa.
Thank you. Um, that's I love that comment because I think that um so much of health and health decision making is being in uncertainty. And of course we want to reduce the uncertainty as much as we possibly can and we get our agency from making the right decisions with the best information. we might have but um It's it's fundamentally a scary, stressful place and often a very lonely place. Um and but at the end of the day, uncertainty while we always want to reduce it and learn what we can, it's never fundamentally completely reducible or usually not. And in fact, we need that uncertainty for that hope, for to drive learning, to drive action and to drive, you know, continually improving. Um, and so that's one of I think many reasons why the topic is so um important and interesting.
Um, I guess I I appreciate your question, Pamela, about moments because uncertainty really is I think it's about millions of moments, tiny moments where information gets communicated well or or inaccurately and where decisions get made consciously or not, or where hope is you know, the door to it is open and the journey is accelerated or the moment where it's It's shut down and it's so devastating.
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Chapters
6 chapters
1
What word do listeners associate with uncertainty in medicine and why?
0:00–11:48
2
How can uncertainty evoke both anxiety and excitement for patients and clinicians?
11:48–22:11
3
Why is embracing uncertainty important for building trust in the patient‑doctor relationship?
22:11–32:41
4
What myths exist about certainty in clinical decision‑making and how can they be challenged?
32:41–43:05
5
How did the pandemic highlight the tension between over‑testing and watchful waiting?
43:05–52:46
6
What role does technology (AI, decision‑support tools) play in managing clinical uncertainty?
52:46–55:02