Uncertainty and decision making

Uncertainty permeates many aspects of healthcare delivery. We like to think that biomedical science drives clinical practice and thus lends us the certitude of scientific inquiry. In reality, each patient is unique, so consequently many scientific facts do not apply to individual cases. Health professionals and patients are required routinely to make decisions in uncertain circumstances. This chapter examines the theoretical underpinnings of uncertainty, the characteristics of complex adaptive systems, and how health and healthcare express those characteristics. We explore the effect uncertainty has on health professionals and patients, and look at interventions to improve health professionals’ tolerance for uncertainty. Also highlighted are the key features involved in making a decision, with a focus on decisions made in the context of medical uncertainty. Finally, we look at how shared decision making is influenced by the health professional–patient relationship, and how that in turn influences health outcomes. The chapter closes with activities that provide the opportunity for experiential learning related to uncertainty and decision making.