Clear communication about uncertainty can help clinicians and patients better cope with unexpected or undesirable outcomes.
In medicine the stories
Come fast and thick
In the hospital the unknowns twist
And characters enter stage ER
Faster than you can
When you are a certain kind of
Black bones tired
Everything feels like a dream anyway
And so so emotional
People die with disturbing regularity until it is only
Families and they seem to be hamming up the
Scene and you just want to
Check the fridge to make sure you didn’t leave
Anything smelly in it 48 hours ago
When you left home
But the fridge is near the bed so you
Don’t although you hope you got all the
So that is when you start to see
Now-right and future-wrong
It’s about the time you stop….
Needing to change the plot
And stand back, a precise narrator
Sometimes intervening, but always on script
And you see that you are caught
Because the now-right could easily be future-wrong
And the people in front of you
Can’t see it
You can say all the [conveying uncertainty] and [autonomous decision-making]
You want but they will only remember
It right if the ending is
And you don’t write the endings
The story is convoluted and you can
Barely make breakfast, in fact you
Didn’t eat that day
Time can be a bitch
When emotions happen out of
And sometimes all you can do is
Carve a space out of the air
And a silence to emphasize
That a decision is being made
Including a trembling tremulous poorly fed and
Will have to face
Decision fatigue the AMA calls it, as if it could be so neatly summarized. What we wish patients knew about our work. It affects everything, our mental and emotional exhaustion, surgeons’ choice to operate, whether to administer cancer screening tests. It leads us to overly rely on the status quo, the heuristic, the absolution of choice. Yet there is more: the unpredictable nature of the outcomes. What you know that they don’t: that you are not in control.
We sometimes think we can control everything, but we can’t. And clinicians know the deep trauma that comes from pretending that we can—only to find out we were wrong. One only needs to reassure a patient falsely once, to remember the unending shame of claiming a right to a future we do not own.
The body is a complex system. Chaos theory describes complex as “multiple component parts that interact in a nonlinear fashion, and the results of their interaction are often greater than the sum of their parts.” Perhaps the most difficult part of medical practice is when the outcomes affect how patients and their loved ones view you, even if you did everything right.
We say terms like “conveying uncertainty” in training. But the reality is this is just compassion. When you know that a decision can only be right in the moment, and only sometimes in the past. When your patients don’t. When you express this the best you can. And when you forgive them for not understanding.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.