Page 6 - Mecklenburg_Medicine_July-August-2018

President’s Letter

Transparent Uncertainty

By Scott L. Furney, MD One could imagine the range of responses, from nonchalant
to terrified. With the facts and frame, I can narrow that possible
W eaving my way through a complex clinic, range and reduce anxiety of the unnarrated facts. I am unlikely
I marveled at the number of times I was to blunt the patient’s emotional response much further, but I can
uncertain about some aspect of a patient’s care. be there to explain and incorporate his wishes into our plan. If I
“How long will this go on? Does my patient am 99.9 percent certain, but the patient cannot sleep at night, my
have early appendicitis? Will this medication work, when the 0.1 percent uncertainty is only good enough for my conscience.
others have not?”
You can see now why I was drawn to the short poem by
In this short Life that only lasts an hour Dickinson. All I can do is be transparent with my uncertainty
How much — how little — is within our power and let the patient’s preferences guide us to the compromise
that satisfies our differing needs. When done well, I can exit the
— Emily Dickinson room feeling comfortable that we share in the uncertainty.

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uncertainty in their care? Does
this change how much you

response much further, disclose? Is it ethical to release
information that will make a

but I can be there to patient worry unnecessarily, or
explain and incorporate unethical not to?

At issue today were two

his or her wishes into incidentalomas. Ordering
a scan that was indicated, I

our plan. stumbled upon two simple
cysts. One was in the kidney

and one “too small to

characterize” was in the pancreas. With medical knowledge

and training, one would reasonably conclude that they are

benign and no further imaging is indicated. Am I certain of

this? How should I advise the patient, who is well-educated

and extremely reasonable? I am lucky enough to work with a

medical student, to whom I posed these questions. His answer

helped me, as they often do. He said, “It depends on how

you frame the issue.” Framing is a great answer, but I had to

identify the frame and acknowledge the bias it introduced. In

the end, I sent him the report with the facts of the case, framed

around my logic and my recommended approach. Now that I

have dealt with my uncertainty, I wait with baited breath for

the patient’s response.

6 | July/August 2018 • Mecklenburg Medicine