Uncertainty in Medicine A Framework for Tolerance

Medical uncertainty has been with us for centuries and remains a recurrent problem for patients, doctors, and researchers alike. Yet uncertainty in health care is still poorly understood and ineffectively managed; it is generally feared and avoided rather than directly confronted. This systemic disregard of uncertainty leads us to treat medical uncertainty as a pathological condition to be cured through the pursuit of knowledge, but often further medical knowledge begets further uncertainty in kind.

Uncertainty in Medicine offers an alternative, multi-disciplinary perspective on this challenging problem. Integrating insights across clinical medicine and social science, Dr. Paul Han argues that uncertainty is an essential form of knowledge to be cultivated, rather than eradicated, in medical practice. He makes the case that the paradigm of medicine should be expanded to include not only the pursuit of medical knowledge but the treatment and palliation of medical uncertainty and its effects on physicians, other health professionals, and patients. Using clear language and a textbook approach, he analyzes the nature, etiology, and natural history of medical uncertainty, and develops a conceptual framework to guide its management. By promoting a more systematic way of conceptualizing the problem, this framework can enable clinicians and patients to better address medical uncertainty, and can help make uncertainty tolerance a more central focus of medical care.

Rational and reassuring, Uncertainty in Medicine forges a new path for approaching medical uncertainty by arming readers from an array of disciplines with the tools they need to diagnose, treat, and confront its challenges more intentionally and effectively.

Paul K.J. Han, MD, MA, MPH, is Senior Scientist at the National Cancer Institute. He has worked previously in clinical practice as a general internist and trained medical students and residents in risk communication and shared decision making.

Acknowledgments
Preface

Chapter 1: Introduction: The Challenge of Uncertainty in Medicine

Chapter 2: The Nature and Etiology of Uncertainty

Chapter 3: The Anatomy of Uncertainty

Chapter 4: The Natural History of Uncertainty

Chapter 5: The Management of Uncertainty

Chapter 6: A Way Forward: Systematizing Uncertainty Tolerance

References
Index