RP101 – Uncertainty

Session Readings



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. Some have described this as “the fog of healthcare” a reference to the well-known “fog of war”. JThis 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. 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 listen to three narratives focusing on uncertainty.  In those narratives, you will hear sub-themes of uncertain diagnosis, treatment and prognosis as well as consideration of the positive and negative implications of uncertainty. As you listen to the panelists, I ask you to identify your reactions to the uncertainty they describe, explore the sources for those reactions, and examine the implications of those reactions for the patient care you have delivered and will deliver in the future.

Assignment – Reflective Essay (R.S.I.P. format)


As stimulated by your past experiences, the panelists’ narratives,  and the supplemental resources, identify your thoughts and reactions, including each of the following:

  • Your thoughts and feelings about having to make a diagnosis and develop a treatment plan in a situation in which the correct diagnosis (and thereby the optimal treatment plan)  is uncertain
  • Your reactions to two or more of the panelists’ narratives or supplemental resources as they relate to uncertainty that struck you as particularly poignant

*Note: When writing this section, list your affective reaction followed by 1-2 lines describing those aspects of the panel/resources that evoked your reaction.

Sources/Your Story:

Through the medium of your personal narrative, explore the sources of these thoughts, feelings, and reactions. Your narrative must include specifics and be written in the first person. Your sources should include an exploration of the following:

  • One’s experiences dealing with uncertain situations in the past
  • How uncertainty was dealt with and discussed in one’s family of origin
  • How uncertainty was dealt with and discussed in the community, culture, religious group, etc. in which one was raised
  • How one perceives uncertainty to be viewed in the military community, medical community, and one’s current family/community.


Analyze the implications of one’s reactions to uncertainty in healthcare for the way one cares for patients when the path ahead (diagnosis, patient desires, treatment, prognosis, family desires) is uncertain. At a minimum, this analysis will include consideration of the following questions:

  • What challenges does coping with uncertainty pose for you?
  • What do you think you will do in such a situation and what are the impact of those anticipated actions? Be sure to include both the positive and negative implications for each of your reactions.


Develop a realistic and specific plan that you think will help you cope with the challenges you anticipate facing in uncertain situations as a healthcare provider. Note: The reality of healthcare is that there are many situations in which there are no certain answers – for anyone. Your task is to consider how you will cope with these situations. With this in mind, a plan of finding a fictitious, theoretical “someone else” who is certain is neither realistic nor viable, and will require remediation. Similarly, a plan of “learning more so I will have less uncertainty” while potentially helpful, avoids the challenge of reflecting on how you will cope with uncertainty when it is unavoidable and will require remediation as well. 

Note #1: Submit your paper in Sakai as a Word document.
Note #2: Include your last name in the file name.
Note #3: Include your email address in the header of your paper.

NPRTrapped in His Body for 12 Years, A Man Breaks Free by Lulu Miller (NPR) At the age of 12, Martin developed a mysterious illness. Over the next 2 years, he progressively lost his ability to communicate, until, at age 14, he entered what his parents were told was a permanent vegetative state. Two years later he began to “wake up”; 10 years after that he was able to finally communicate again.
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The Journal of the American Medical AssociationAdverbs by Khanjan Baxi Shah, MD Medicine is not mathematics. Uncertainty is in fact truth. Logic is often unbound to reality. Humility lies in Adverbs. A story of uncertain diagnosis.
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