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Why doctors should embrace uncertainty for better patient outcomes

Recently, I met a coaching client for her second session. As we greeted each other, it was immediately apparent that her energy and mood had shifted from the first session. She seemed lighter, her shoulders were higher, and her posture was straighter. There were smiles instead of tears.

In the initial session, we discussed pressures and expectations. It became clear that these were largely internally generated. Like many doctors, this person had uncompromising expectations of herself.

Perfectionism involves an underlying anxiety tendency, as well as a need to be certain – to be right.

As we completed the first session, we discussed taking a different approach, looking at things from another perspective, and deriving self-worth from internal measures as opposed to perceived external feedback. In addition, we commenced a gratitude practice and a type of breathwork.

At the second session, the doctor announced that the first meeting had “changed her life!” While this was a wonderful affirmation, I wondered if it could be true. Could a single session really change someone’s life? Would that change be maintained, and did it need to be? Or had the slight nudge in trajectory already set her on a different and more fulfilling path?

In medicine and health, we implicitly learn that it is important to be and appear certain when dealing with patients and others. We, therefore, consciously and unconsciously cultivate an image of being all-knowing, not encompassing doubt.

Accuracy and confidence are, of course, critical in so much of healthcare. But could an overreliance on certainty sometimes lead to negative consequences for ourselves and our patients? Excessive over-certainty could lead to embedded inflexible attitudes and a type of naive realism, where our view of the world is believed to be the only reality.

When these rigid attitudes and beliefs become pervasive, often at the stage of being a junior doctor, they may allow for a degree of comfort with less self-doubt and fear. Indeed, adopting this mindset may be adaptive, as it reduces the need for cognitive resources to be diverted to consideration of unpredictability or uncertainty.

But does this benefit patients? Does it limit our own positive emotions and creativity, and does it reduce our ability to visualize alternate possibilities and different futures? Does it mean that we overcommit to a particular diagnosis and treatment?

This fixed mindset, perfectionism, and need to be right could lead to less empathy for our patients. It could result in giving a ‘factual’ and harsh prognosis without allowing for the unknown, or indeed the unknown unknowns. It may lead to less hope for the patient and family – and we know that once hope is lost, clinical outcomes deteriorate.

As the parent of a now-adult child with a significant lifelong diagnosis, I have met with multiple specialists. Some have given a bleak textbook outlook devoid of any positives. This has left me feeling deflated, defeated, and helpless. What is the point of going on? I have also dealt with doctors who have acknowledged that even in a difficult situation, none of us can truly know the future. Even in an awful situation, we don’t know exactly what can happen.

These doctors manage to retain their authenticity and recognize the challenges while still allowing for a degree of hope. I know which of the above doctors’ attitudes I prefer. Hope is energizing—it enables you to take forward steps and continue to battle.

So, could this image that we cling to – of being right, certain, perfect, all-knowing – the attitudes that we unconsciously associate with a ‘superior’ doctor, also lead to a single viewpoint and an inflexible attitude?

A circumscribed way of being, a limited range of allowable emotions, and over-reliance on suppression as a form of emotional regulation may not be in the clinician’s best interests, either. A rigid thinking pattern, need for certainty, and emotional suppression are implicated in burnout, especially when we reach the point where there is no joy in our work.

What would be the effect of adopting a different lens, seeing alternative viewpoints, and acknowledging other perspectives? Would it lead to less individual certainty in one’s own world? Would it lead to a loss of credibility as a clinician?

Or would the reverse occur? Would you generate positive emotions, feel happiness, allow your patients to have increased hope, and become better doctors with a broader scope and increased ability to connect?

These seemingly simple attitudinal changes may be able to create powerful positive outcomes. Perhaps a discussion of, and thinking about, how one thinks is really important and necessary for us all.

Maybe facilitating broader perspectives and enabling a wider range of attitudes really can change a life.

Simon Craig is an obstetrician-gynecologist in Australia and author of From Hurting to Healing: Delivering Love to Medicine and Healthcare.

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