Have you ever remodeled your kitchen? So many decisions: Cabinet style, drawers, finish, hardware, not to mention the floor and appliances. There’s you, your partner, a contractor, a cabinet person, a floor person, the appliance merchant. Decision after decision – should we or shouldn’t we? And nobody’s gonna die or get injured – hopefully. All while trying to keep living, cooking, dishes, lunches. My wife and I were so stressed. Kitchen decisions pale next to health decisions, especially medical decisions. It’s not like, “do I prefer this drawer pull to that drawer pull?” “Would I rather have wood or tile floors?” There is so much more uncertainty in health care.
Why me, why now? Who says? How sure are they? What if I do? What if I don’t? Will I still be able to ….? Who pays? What will they think? How do I get there? What aren’t they telling me? Are they listening to me when I say I can’t or I won’t? I just can’t think right now! Oh, this sure sucks!
I’ve only met a handful of people in my 40+ years in healthcare who seem comfortable with talking about uncertainty. This includes family, friends, people I’ve cared for, other clinicians, caregivers, researchers, clergy, children, adolescents, adults. Yet uncertainty is everywhere. We know with absolute certainty that we need water and air to live, don’t cross a busy street without looking, and wear a parachute when you jump from the sky. No studies needed. But from there – uncertainty. Research can tell us that this is more likely to work than that for a specific population under specific conditions. A certain percentage of people live some days longer if treated with this and not that.
When was the last time you had a conversation about the uncertainty of evidence? It could have been about risks – you could die if we do this surgery. Unlikely, but possible. Sign here. I read an article recently by Politi, Han, and Col, Communicating the Uncertainty of Harms and Benefits of Medical Interventions published in Medical Decision Making. A robust, thorough article that left me overwhelmed and confused. I spoke with one of the authors, and she told me it was one of the hardest articles she had ever written. I can see why.
I’m pretty certain that communicating uncertainty is key to informed decision-making. I’m just not sure how certain. HELP!