‘Accepting uncertainty in medicine’

TAUREEF MOHAMMED

I covered the covid19 ward at our hospital for the first time last week. As the junior resident, I remained overnight, handling issues on the ward and admissions. “Don’t feel bad to call if you need help. We are all trying to figure this out,” my senior said as he left. I was relieved.

From the moment the pandemic started, uncertainty has defined every moment of it. New information is being discovered about covid19 by the hour; there has been an exponential increase in research papers. Despite the herculean effort by science, uncertainty abounds.

Speaking at a virtual symposium – Covid19: Where Do We Go from Here? – hosted last week in the US by the Harvard TH Chan School of Public Health and New England Journal of Medicine, Arnold Epstein, chair of the Department of Health Policy and Management at Harvard, lamented, “We’re stuck flying the plane and building it at the same time.”

Although uncertainty during the covid19 pandemic is almost stifling, its lurking presence certainly is not new to medicine or any other science. Uncertainty defines what we doctors do every day.

“I had never expected medicine to be such a lawless, uncertain world,” Siddhartha Mukherjee, Pulitzer Prize-winning author of The Emperor of All Maladies, wrote in his book The Laws of Medicine. An oncologist and researcher, Mukherjee reflects on medicine’s history and his experiences to show the “incompleteness, imprecision, and uncertainty,” that define the profession.

By no means does this suggest that doctors operate blindly. Patient X complains of a headache. What is the likelihood that this headache is caused by tension versus a viral illness versus a tumour? Should we order a CT scan of the brain?

Years of medical school, followed by years of specialty training are geared toward balancing the inherent uncertainties in the answers to these questions – but the uncertainty remains; it doesn’t go away.

One consultant in TT, whom I worked under and have great admiration for, noticing my frustration at times, would reassure me: “Don’t worry, doc. Eventually you’ll learn to smell out the diagnosis.” Doctors have to be comfortable with uncertainty; if not, we run the risk of being crippled by the fear of being wrong.

The other extreme is equally true: overconfidence will lead us to making fools of ourselves. “If you are doctor for five years and you have any hubris left, you are in the wrong profession,” Jon LaPook, professor of medicine and chief medical correspondent for CBS News, said at the virtual symposium.

But what about the general public, the patients – how comfortable are they with the fact that this centuries-old profession is one fraught with uncertainty?

After all, their lives are at stake. I am not sure if they’re comfortable. And if I was a patient I’m not sure I would be comfortable either.

Judging from media reports over the years, we cannot deny that the patient-doctor relationship can be improved. How much of the breakdown of this relationship is related to our failure to communicate openly and effectively the uncertainties of our profession? How much of it is related to the public’s reluctance to recognise that medicine, like any other science, has uncertainties? I don’t know the answer.

What I know is covid19 has brought us to a crossroads. The uncertainty we face is glaringly obvious, and, guided by Chief Medical Officer Dr Roshan Parasram, healthcare workers have been navigating uncharted territory, and the public for the most part have been patient and understanding.

I asked a few friends what they thought of the CMO. “He seems calm, measured, and trustworthy,” one said. Another added, “Seems to be grace under pressure.”

In this time of uncertainty, the panellists at the virtual symposium said, communicating honestly to an anxious public is absolutely important. Similar sentiments have been echoed by Barack Obama. It appears the CMO is doing just that and in so doing, he stands as a model to all of us in this noble profession. Indeed, the CMO-public relationship is solid.

Taureef Mohammed is a graduate of the University of the West Indies and an internal medicine resident at Western University, Canada.