Unlearning Certainty

The first two years of medical school come down to identifying an answer. The answer.

It’s always nestled among five choices, at the bottom of  a carefully constructed paragraph that includes all the information and buzz words we need.

Being a great first or second year student becomes of game of plodding through the cycle of memorization and regurgitation. We learn to see medicine as a series of singular issues that require nothing more than facts and textbooks, and come to believe that pure intellect will let us plow through patient problems with accuracy and efficiency.

Fortunately, medicine is an intricate, ongoing dance between science and compassion, in which we must not only memorize, diagnose, and treat, but also listen, connect and unpack. 

Clinical care that brings patients and physicians together does not stem solely from narrowing down answer choices and recognizing patient presentation patterns. It also unfolds out of recognizing the limitations of certainty and the importance human-to-human trust in healing the body and the soul.

We all have the choice to stop playing the game of certainty. To do less fact regurgitation and more patient engagement. If we do that, we might get a little closer to being the kind of doctor we thought we would be when we first got our crisp, overly starched white coats.

One who refuses to stop at being right and instead, also focuses on doing right. One who constantly circles back to the uncomfortable questions of “Am I sure about this?”,  “What am I missing?”, and “Are we meeting your priorities in your treatment?”

Once we hit the requisite threshold of facts, making the move from good to great depends less on what we know, and more on how often we choose to show up with the presence, attention and humility that keeps us forever curious.


  1. says

    Very insightful Jack
    I’m reminded of a memorable quote by someone sharp “The illusion of certainty versus the reality of uncertainty”. It’s almost 30 years ago but feels like yesterday – that sinking feeling when all the clinical facts enthusiastically learned, empowering, (invincible even!) didn’t correlate with the patient in front of me.
    What do I accept as reality, what is superfluous to appropriate care? Thus rages the conflict between the art and science of medicine. I wish you well my friend.

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