Physicians: Get comfortable with uncertainty

A new book challenges the one thing physicians find unsettling — ambiguity.

"Psychologists have shown that there is a fundamental tension between the ubiquity of ambiguity and our natural preference for definite answers. Misunderstanding that tension and putting too much faith in tests to resolve ambiguity, it turns out, is one cause of medical overtesting," reads an essay in Slate adapted from the book, Nonsense: The Power of Not Knowing by Jamie Holmes.

The Slate adaptation lines up a number of studies to support the idea that we may need more gray thinking, not black-and-white thinking, in medicine. One such study showed physicians ignored ambiguous symptoms of general chest pain 22 percent of the time. The clinicians acknowledged the symptoms were vague 77 percent of the time, but followed up by ordering a test. While this may be appropriate, according to the report, it can lead to stream of unnecessary tests and inflate costs.

The issue, according to the report, is that tests can detect abnormalities, but not necessarily whether those abnormalities will be an issue. An experiment looking at MRIs of baseball pitchers found almost all the players had abnormal rotator cuff damage and shoulder cartilage, despite that they were all healthy, according to the report.

Rather than placing disproportionate confidence in scans, tests and imaging, the author challenges physicians to shift their focus to the patient.

"New ways of seeing aren't necessarily clearer ways of seeing, and sometimes, the illusion of knowing is more dangerous than not knowing at all," the author wrote.

Read the full essay here.


More articles on integration and physician issues:

NewYork-Presbyterian amends decision to shutter family medicine program
Study: MDs, NPs, PAs offer similar cardiac care
Ohio Independent Collaborative grows by 300 physicians

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