The
aim of these reflections on uncertainty in medicine is not to discredit
evidence-based medicine or to incite suspicion of the careful and caring
processes by which most clinicians arrive at the advice they give. Rather it is to change conversations among
practitioners and between them and their patients in such a way as to raise
everyone’s tolerance for the inevitable ambiguities and uncertainties we live
with. If the public were more aware of
the basic rules of mathematical probabilities, how statisticians understand the
term “significance,” and of how much changes when one new variable is taken
into account—when a new medication with multiple possible side-effects is added
to the mix, for instance—they might, Hatch argues, be less inclined to insist on
specific predictions. He goes on to
suggest that there is something to be gained from the challenge of living
without the solid ground of assurances.
When we recognize the need to make decisions with incomplete information
(a condition that seems, after all, to be our common lot) we may refocus on the
moment we’re in and see its peculiar possibilities. Changing the conversation
requires a critical look at medical education which, Hatch observes, “measures
a certain type of knowledge essential to medical practice, but it consequently
engenders a conception of medicine best described as overly certain . . . .”
