Bearing the Burdens of Medical Uncertainty

RATIONALE: Uncertainty comes in many kinds, is ubiquitous in all parts of clinical work, and is burdensome to physicians, patients, proxies and policy makers. Moreover, it leads to a range of adverse responses such as excessive testing and interventions, overdiagnosis and overtreatment. While the technical aspects of uncertainty are widely accounted for, the burdens of uncertainty need closer scrutiny. AIMS AND OBJECTIVES: The aim of this article is to investigate the complex burden of uncertainty for clinicians: as health professionals, carers for patients, and human beings facing the unknown. METHOD: A conceptual analysis is applied introducing a case to illustrate the diverse aspects of uncertainty reviewed in the literature. RESULTS: We identify six types of burdens of uncertainty: cognitive, emotional, behavioural, social, moral and existential and show how they play out for clinicians in clinical care for their patients, as health professionals, as caregivers and human beings. Moreover, we suggest specific strategies for bearing these various types of burdens of uncertainty in all roles. CONCLUSION: Bearing the burdens of uncertainty is crucial for professional integrity, well-being, and communication with patients, but also for improving the quality, safety, efficiency and sustainability of healthcare.