Faculty Scientist / Associate Professor - Maine Medical Center / Tufts University School of Medicine
Understanding and Managing Uncertainty in Health Care
The purpose and goal of my project is to complete the final chapter of a book, Understanding and Managing Uncertainty in Health Care, which I am writing under a publishing agreement with Oxford University Press. This book will enable health professionals, patients, and laypersons to better understand and more effectively manage the uncertainties that arise in health care. It focuses on three main tasks: 1) analyzing the meaning of uncertainty and its sources, manifestations, and consequences in health care; 2) developing a rational approach to uncertainty, based on its diagnosis, prognosis, and management; and 3) analyzing the meaning of uncertainty tolerance and identifying strategies to increase this tolerance among patients and health professionals.
The book synthesizes insights from multiple disciplinary perspectives—e.g., clinical medicine, health services research, bioethics, anthropology, sociology, philosophy, religion—to propose a new way of thinking about uncertainty and its management. It identifies theoretical and methodological limits to certainty in health care, focusing on knowledge of the probabilities and human values that guide all medical decisions. It utilizes case narratives to illustrate how irreducible uncertainties—e.g., regarding diagnosis, prognosis, and treatment effectiveness—are manifest and managed in clinical practice.
The book ultimately puts forth a new understanding of uncertainty as a higher-order, metacognitive perspective with negative but also positive effects: enabling true wisdom, promoting empathy, strengthening patient-provider relationships. Health care should thus strive not only to reduce ignorance whenever possible, but to simultaneously increase uncertainty (awareness of ignorance) and to help patients and clinicians tolerate its negative effects. This task requires not only informational but emotional and relational support. The project reviews evidence on the components of such support, suggests promising strategies for clinical practice, and identifies knowledge gaps for future research.