The “uncertain” space

In preparation for the current blog series, I have spend a decent amount of time researching the concept of uncertainty in medical decision making. Several articles have jumped out, some of which I will be posting. This idea of becoming more comfortable with being unsure about diagnoses and the practice of medicine has in many ways been therapeutic, maybe even more so than being a professional and intellectual question. I know I am not comfortable with not  knowing. In my heart, I have always been concerned that, if I expressed my uncertainty, I would be judged and belittled. 

It was a source of comfort, then, to find so many articles in which others felt the same way. It is easy to isolate ourselves in busy schedules;  creating the space to be vulnerable with a person we trust is a great luxury. It is not always readily available. 

One of the emails I get almost every day is from the Center for Action and Contemplation, a site devoted to the meditative practices of Christianity. Richard Rohr, whose writings are on the blog, speaks in such a way that I wonder how he knows exactly what I need to hear on any given day. Today was no exception. 

https://cac.org/faith-and-doubt-are-not-opposites-2021-02-03/

It’s a short read that almost begs to be re-read and digested. 

The post today was about uncertainty in a spiritual sense. One of the things Rohr talks about is the natural path from faith to doubt, and back to faith again with the knowledge that our faith rests in the Divine, not in the apparent “reality” we perceive. The questioning, that space of uncertainty, takes us to a stronger place. Even if it doesn’t feel good at the time.

“What has happened to our ability to dwell in unknowing, to live inside a question and coexist with the tensions of uncertainty? Where is our willingness to incubate pain and let it birth something new? What has happened to patient unfolding, to endurance? These things are what form the ground of waiting. And if you look carefully, you’ll see that they’re also the seedbed of creativity and growth—what allows us to do the daring and to break through to newness. . . .

Creativity flourishes not in certainty but in questions. Growth germinates not in tent dwelling but in upheaval. Yet the seduction is always security rather than venturing, instant knowing rather than deliberate waiting. “  – Sue Monk Kidd

Wow. That last line. 

Actively venturing into the space of uncertainty is a necessity, just by virtue of the art we practice. We can never know it all, yet deliberately wading into the sea of what we have yet to learn for the benefit of those we serve is at the core of what makes us effective as health care professionals. 

Thank you for reading. Peace. 

Sue Monk Kidd, When the Heart Waits: Spiritual Direction for Life’s Sacred Questions (HarperSanFrancisco: 1990), 25.

Richard Rohr, Falling Upward: A Spirituality for the Two Halves of Life (Jossey-Bass: 2011), 111‒113; and

Richard Rohr, The Naked Now: Learning to See as the Mystics See (The Crossroad Publishing Company: 2009), 117.

This week : Uncertainty and the process and practice of diagnosis

This link below is to an article posted in the Lancet online Psychiatry posted last week regarding medical diagnosis and uncertainty in the face of Covid-19. 

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00031-6/fulltext

Health professionals sat down in pairs to discuss their response to the currrent health crisis. They were recorded, with names scrubbed for anonymity. Two things were observed. The first was the pervading sense of uncertainty about how to proceed and care for patients during this pandemic; the second was that there was no one to talk to about the first. The article recommends the following as a course of progress. 

“Charting a course of action in the face of uncertainty—an uncertainty that sows doubt about one’s own professional role and value—is not simply a matter of having access to information. It requires being psychologically ready and able to bear that feeling to determine what best can be done, even when knowledge is restricted. Achieving this readiness requires that the doctor (or nurse) recognises that they are not alone—they are part of a community of peers. A community in which they can, privately and securely, express concerns about feeling ineffective, powerless, and isolated—enervating states often associated with shame. In other words, managing uncertainty is rooted in two requisites: first, a state of mind able to bear uncertainty, yet still act; and second, knowledge, which in this case was at first too scarce and then only incrementally expanded. Not attending to the former requisite arrests entry into the latter.”

I love this. Mainly because I think I have had this feeling so often, and yet never had the courage to talk about it (except to my husband, a pulmonologist. Poor guy. He’s probably really happy I have this blog so I don’t subject him to my mental meanderings).  “[A] state of mind able to bear uncertainty, yet still act”. 

For us, accepting the state of being uncertain, having the strength to admit it to our peers, and allowing it to be a gateway into a greater state of information and wisdom is not only beneficial to our patients. It is essential to our well-being as clinicians. 

Before I go, if you want to gauge your tolerance of uncertainty as we go into this week, here is a quick little internet quiz.

https://www.newscientist.com/article/2220324-quiz-how-well-do-you-cope-with-uncertainty/

Hang in there, friends. Please read, post, share, and maybe most importantly, BREATHE. Peace.