Uncertainty in the Clinic: the Importance of Adaptive Expertise for Dealing with Complexity

Patients with complex care needs often experience a range of challenges, including physical and mental health issues, and cultural, social, and economic factors that limit access to the determinants of health. [...]a Canadian study found that high-cost users of the health care system (an indication of multi-morbidity) are disproportionately female and low-income, which are social indices of poverty and social oppression rather than biological factors [2]. Patients with multiple problems, especially comorbid psychiatric illness and psychosocial stressors, are more likely to present with uncertain diagnoses that create ambiguity for providers. [...]health systems, hospitals, and clinicians are driven by resource, time, and compliance pressures, often applying evidence without consideration of the complexity of care [5]. Though many physician experts practice in this way, it is rare for teachers to make their uncertainty explicit. [...]clinician teachers must model epistemic humility, and explicitly demonstrate how uncertainty can catalyze ongoing skepticism to continually revise hypotheses [8, 11, 12].