Background

In every facet of healthcare, we are faced with uncertainty.  Despite various strategies to reduce this uncertainty, such as the use of evidence-based guidelines, we are often still unable to know with certainty whether we have arrived at the correct diagnosis, have designed the optimal treatment plan, and/or have accurately predicted a patient’s prognosis. This idea is especially poignant now, at a time of global pandemic in which the unknowns are myriad and include:

• How long do people shed the virus? Does this differ between those who are and are not hospitalized?
• Are people with SARS-CoV-2 who are asymptomatic infectious? If so, for how long?
• Why do some people without medical problems get very sick, and others with medical problems not?
• What are the true timeline prospects for a vaccination?
• Are there any novel antiviral medications currently in development for COVID-19?

The list of questions (at the current moment in time) go on and on.  Uncertainty in the medical realm has been described as “the fog of healthcare” a reference to the well-known “fog of war”. This lack of certainty can be both frustrating and disquieting, especially when we are faced with the responsibility of making decisions that could have a major impact on the health of our patients and their families.

In these uncertain situations, our reactions can not only impact our own cognitive processes, but can, through verbal and non-verbal communication, impact our patients  – at times evoking their anxiety and undermining the confidence they have in their healthcare. Focusing on such anxiety might seem superfluous in our current situation, until one realizes that anxiety often causes tachypnea and tachycardia which could be interpreted as a worsening clinical picture, and lead us to more aggressive treatment.

At the same time, uncertainty has its benefits – it can lead us to a closer examination of the information we have available, to a deeper contemplation of the situation at hand, and to more effectively joining with our patients in a partnership to find the best way forward.

This session offers you the opportunity to reflect on your own experiences with uncertainty and to watch/read/listen to resources that include discussions about uncertainty.  You will hear sub-themes of uncertain diagnosis, treatment and prognosis as well as consideration of the positive and negative implications of uncertainty.

Assignment

1. Prior to the session, download this Chrome extension which will let you go into grid view in Google Meet: https://chrome.google.com/webstore/detail/google-meet-grid-view/bjkegbgpfgpikgkfidhcihhiflbjgfic?hl=en-US
2. Come to the small group with notes regarding your thoughts in response to the following questions:
   1. What are your reactions to the idea of having to make a diagnosis in a situation in which the correct diagnosis is uncertain?
   2. What are your reactions to the idea of implementing treatment plans for your patients without having certainty whether the treatment will help or harm?
   3. Identify a poignant aspect of one of the resources (or another resource that you identify) and come prepared to share that with the group.
3. As you think about your answers to #2, please reflect on the following:
   1. Your experiences dealing with uncertain situations in the past
   2. How uncertainty was dealt with and discussed in your family of origin
   3. How you have observed others cope with uncertainty in the community, culture, religious group, etc. in which you were raised
   4. How you have observed others cope with uncertainty in the military community to date