Uncertainty In Medicine: Jonathan Ilgen and Gurpreet Dhaliwal

The only certainty in medicine is uncertainty. It touches every aspect of clinical practice, from diagnosis to treatment to prognosis. Despite this, many clinicians view uncertainty as something to tolerate at best or eliminate at worst. But what if we need to rethink and reframe our relationship with uncertainty in medicine?

In this episode, we sit down with Jonathan Ilgen and Gurpreet Dhaliwal, co-authors of the New England Journal of Medicine article, "Educational Strategies to Prepare Trainees for Clinical Uncertainty." Together, we explore the nature of uncertainty in clinical practice, its effects on trainees and seasoned clinicians, and strategies to embrace it as a fundamental part of medical reasoning rather than a regrettable byproduct.

Jonathan and Gurpreet share insights from research and clinical experience, offering practical methods to help trainees and clinicians recognize, manage, and even embrace uncertainty. Key topics we discuss include:

• The paradoxical nature of uncertainty: When perceived as a threat, it can provoke anxiety or fear; yet when framed as an opportunity, it can inspire hope and optimism.

• Why uncertainty is inevitable in medical practice and its impact on clinicians.

• Is uncertainty a state or a trait?

• The distinction between epistemic uncertainty (knowledge gaps) and aleatoric uncertainty (randomness in outcomes).

• How experienced clinicians utilize strategies such as forward planning and monitoring to navigate uncertainty.

• Communicating uncertainty with patients: how to do it effectively without eroding trust.

• How to integrate uncertainty into medical education.

During the conversation, we explore the emotional responses to uncertainty and how these reactions can influence clinical practice and decision-making.

Importantly, Jonathan and Gurpreet emphasize the importance of openly communicating uncertainty with colleagues, supervisors, and patients—a practice that, contrary to common belief, actually strengthens trust, fosters transparency, and encourages collaboration. By normalizing and embracing uncertainty, clinicians can better manage the complexities of medicine and build confidence in their ability to care for patients in the face of the unknown.

👉 We're thrilled that Meg Wallhagen, Professor of Nursing at UCSF, has recorded an intro to this week's podcast. Any listener who contributes $1000+ is invited to record an intro to a GeriPal podcast! You can donate here, any amount is appreciated. Also, Meg is looking for practicing or student clinicians (physicians and nurses) who are willing to participate in a study on how a simulation of hearing loss promotes a greater appreciation of the experience of hearing loss. Participation should take no more than one to one and one half hour and you will receive a gift card in acknowledgement of your time. If interested, please contact her directly at meg.wallhagen@ucsf.edu.

For more info, click the following link to open the flyer (PDF format): Information_Flyer_Practitioneer

** NOTE: To claim CME credit for this episode, click here **