Real World Uncertainty

One of the milestones we use to judge pediatricians in training involves uncertainty in the clinical world. We often deal with probability when diagnosing conditions or prescribing treatments. Many times we are convinced that we know what the patent has, but confirming it definitively cannot be easily accomplished, especially in a timely fashion. We make a provisional diagnosis, treat the condition, and, if the patient gets better, congratulate ourselves on our clinical acumen.

At times, the response to treatment remains uncertain, even when the diagnosis is not. A biopsy-proven kidney disease may respond to a certain treatment 90% of the time. If your patient is in the unlucky 10%, then you must develop another plan to try.

We gauge our trainees' abilities to handle this uncertainty that is part of medicine. We discuss odds and statistics with our patients, but how can we help them deal with this uncertainty? This can be especially fraught with potentially fatal illnesses as I am learning on a daily basis. Do we make a long-term goods purchase? How far in advance do we plan things? What will the future hold?

Odds ratios and averages and other statistics give us information, but we cannot know where each patient fits into the disease spectrum until whatever is going to happen happens. It makes having a disease that much  more stressful and frightening.

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