I’ve learned some interesting lessons recently. As my career has taken several unexpected detours, I have experienced some things I have been discussing with patients for a long time.
Uncertainty is a reality for all of us. Life has all kinds of risk- lots of which we deny or avoid thinking about. It is uncertain how things will turn out. We make choices, and they influence the future. The environment can throw us challenges we did not expect. We choose how we respond, and I know the choice of response can be hard, but it is up to us.
One of the most important and difficult conversations I have with patients is about the lack of certainty of their diagnosis or treatment outcomes, and often both. Oh sure, I am a scientist, and I have lots of data, but when the patient in front of me wants to know how certain I am, or how likely it is that their treatment will work…well those are just tough questions. Even the best evidence available to me is based on groups of patients and give me ‘averages’ with which to help the person in front of me. Is this patient like the ‘average in the group studied? This patient could be like the ones who did way better than average, or….way worse. So this conversation about the uncertainty of medical prognosis is critical to trust and patient centeredness. They need to know we cannot be certain, so neither can they. And that can be a gift- it could turn out really well even in the face of uncertainty- I have hope!
So now I find myself thinking through that same conversation with myself (and my wife and friends). I don’t know where my career is going. A job I enjoyed is no longer available to me. Other jobs are. What choices will I have? What do I want? So the doctor/planner has to accept the essential existential reality- I don’t know! And the doctor/planner/father/husband/friend relearns the lesson of ‘breathe, listen, stay open, savor today and right now, and know that the uncertainty is OK.”