Uncertainty
In medicine and science, as in the rest of life, uncertainty plays a bigger role than we are often willing to admit. When reporting the results of scientific experiments or clinical trials, researchers use statistical descriptors to give the probability that the observed result is correct. In reality, no experimental result can ever be determined to be completely certain. Only more or less probable.
Physicians and other clinicians are frequently asked very difficult questions that seek certainty:
Will this chemotherapy treatment work for me?
Are the side effects going to be bad?
Am I going to be cured?
Will my cancer come back?
How long do I have left to live?
These types of questions are so important, yet so hard to answer. Each cancer behaves differently in each patient. Similiarly, each treatment works more or less well, with more intense or less intense side effects in each patient. Yes, we can provide the experience of the “average” patient, what is more likely to happen, based on averages and probabilities. But in truth, treating each individual patient carries a great deal of uncertainty. No two cancers behave the same way. No two patients experience side effects in exactly the same fashion. Will the chemotherapy work or not? If it works, will it work a lot or a little? Will it be hard or easy to tolerate? The answer to these questions are not “averages”…they are the very personal reality lived by that patient.
Why is it then that we look for certainty where it cannot be established? I believe it’s because certainty gives us the feeling of control, and therefore, comfort. If we know what’s coming, we can manage better. But are we just fooling ourselves to get a false sense of control and comfort? Maybe. Probably.
As a patient, it is important to be cognizant of this uncertainty when receiving answers to your questions from your doctor. A physician’s hesitancy to answer such questions with satisfactory reassurance does not mean that he is trying to be evasive. Rather, he may truly not know the answer and may be uncomfortable making a prediction in the face of uncertainty. Patients must advocate for an open discussion in this setting to gain the knowledge that they need to face an uncertain future.
As an oncologist, it is paramount to be realistic about the uncertainties that face a patient, but at the same time not dodge the responsibility to provide a framework for the patient to approach their future: “This is how it goes for most patients, but we won’t know how it will go for you until we try it. I will be your guide the whole way, and we will figure out the answer to those questions together. The farther we get down the road, the clearer the way ahead may be. But ultimately, the answer to those questions may truly be “God only knows!”
