Tolerating Uncertainty — The Next Medical Revolution?


Simpkin and Schwartzstein have written Tolerating Uncertainty — The Next Medical Revolution?  calling for wider acceptance of uncertainty rather than the pretence of eliminating it.

ISO 17025 requires laboratories to consider the uncertainty of their measurements.  This is reasonable.

Image result for tolerating uncertainty

The quality cartel’s inspection bodies get obsessive about it and demands extensive, wasteful work that helps nobody but themselves.  Inspectors need to deal with things as they can be inspected.  Inspecting for the binary of compliance is what they do.  Image result for uncertainty of measurement

Doctors have a more important tasks – including diagnosis, but they can fall into the same trap of seeking deceptive certainty,

Doctors often fear that by expressing uncertainty, they will project ignorance to patients and colleagues, so they internalize and mask it. We are still strongly influenced by a rationalist tradition that seeks to provide a world of apparent security…

“Key elements for survival in the medical profession would seem, intuitively, to be a tolerance for uncertainty and a curiosity about the unknown. Have we created a culture that ignores and denies that requirement? Could our intolerance of uncertainty, in turn, be contributing to the accelerating rates of burnout and the rising cost of health care?…

“- reminding ourselves of Osler’s maxim that “medicine is a science of uncertainty and an art of probability.”  Ironically, only uncertainty is a sure thing. Certainty is an illusion.

Tolerating Uncertainty — The Next Medical Revolution?  Arabella L. Simpkin, B.M., B.Ch., M.M.Sc, and Richard M. Schwartzstein, M.D.  N Engl J Med 2016; 375:1713-1715 November 3, 2016 DOI: 10.1056/NEJMp1606402.

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