{"id":19008,"date":"2016-08-09T09:40:10","date_gmt":"2016-08-09T13:40:10","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=19008"},"modified":"2016-08-10T11:21:22","modified_gmt":"2016-08-10T15:21:22","slug":"how-can-we-cope-with-uncertainty","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2016\/08\/how-can-we-cope-with-uncertainty.html","title":{"rendered":"How can we cope with uncertainty?"},"content":{"rendered":"<p><a href=\"http:\/\/www.skeptic.com\/reading_room\/uncertainty-in-medicine\/\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-19009 \" src=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2016\/08\/Uncertainty-in-medicine-e1470749216874.jpg\" alt=\"Uncertainty in medicine\" width=\"404\" height=\"288\" srcset=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2016\/08\/Uncertainty-in-medicine-e1470749216874.jpg 491w, https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2016\/08\/Uncertainty-in-medicine-e1470749216874-300x214.jpg 300w\" sizes=\"auto, (max-width: 404px) 100vw, 404px\" \/><\/a>We&#8217;ve <a href=\"http:\/\/www.e-patients.net\/?s=uncertainty\" target=\"_blank\">written often<\/a> about uncertainty, which is a recurring challenge in medicine and especially in participatory medicine, where issues of relationship and decisions are core.<\/p>\n<p>Some doctors have told me they were\u00a0<em>trained\u00a0<\/em>to display certainty even when things aren&#8217;t sure, and many patients (in my experience)\u00a0<em>want\u00a0<\/em>certainty about their diagnoses, or at least want their clinicians to act\u00a0confidently.<\/p>\n<p>But our board member Peggy Zuckerman also serves on the patient engagement committee\u00a0of our &#8220;cousin&#8221; the Society to Improve Diagnosis in Medicine, and as <a href=\"https:\/\/participatorymedicine.org\/epatients\/archives\/2015\/09\/breaking-spm-board-member-peggy-zuckerman-on-nbc-nightly-news-tonight.html\" target=\"_blank\">she said on NBC<\/a> last year, diagnosis\u00a0ain&#8217;t always easy. And when things don&#8217;t work out well, patients can feel wronged and clinicians can be blamed.<\/p>\n<p>I wonder, what if we could all accept uncertainty and cope with it together?<\/p>\n<p><a href=\"http:\/\/www.skeptic.com\/reading_room\/uncertainty-in-medicine\/\" target=\"_blank\">An article on uncertainty<\/a> last month in <em>The Skeptic<\/em>\u00a0discusses the reality. On Facebook our board member Peter Elias MD called it\u00a0&#8220;a fine and pretty comprehensive review of how much uncertainty there is in medicine.&#8221; Here&#8217;s the first part, with some added returns for easier reading:<!--more--><\/p>\n<blockquote><p>One of the reasons I went into medicine was the na\u00efve idea that doctors always know what to do. I was wrong. Marya Zilberberg got it right when she said, \u201cThe only certain thing about medicine is uncertainty.\u201d Patient histories are uncertain, physical exams are uncertain, tests are uncertain, diagnoses are uncertain, treatments are uncertain, even human anatomy is uncertain.<\/p>\n<p>Doctors are not scientists; they are practical users of science who <em>apply<\/em> scientific evidence to patient care. Medicine deals in probabilities and informed guesses, not certainties.<\/p>\n<p>Symptoms can mean many things. They can be a sign of serious illness requiring treatment, an illness we don\u2019t yet know how to identify and treat, a benign condition that will resolve without treatment, a hyper-awareness of normal bodily functions, depression, somatization disorder, malingering, or a cry for help.<\/p><\/blockquote>\n<p>How can we cope with this? Any ideas? Patients and clinicians, what&#8217;s your experience with this?<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>We&#8217;ve written often about uncertainty, which is a recurring challenge in medicine and especially in participatory medicine, where issues of relationship and decisions are core. 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