Arising of Uncertainty in Clinical Practice

Hiroto Ushizawa
Volume 6 Issue 2 Pages 1-18
First Published: December 25, 2023
[in Japanese]



As long as medicine as a science is always incomplete, uncertainty always remains in clinical practice, which confounds both patients and clinicians. There are five types of uncertainty in clinical practice: (1) Epistemic uncer-tainty, (2) Conflicting uncertainty, (3) Individual uncertainty, (4) Psychiatric uncertainty, and (5) Value-based uncer-tainty. Methods for dealing with these types of uncertainties include (a) Clinical reasoning, (b) Shared decision mak-ing, and (c) Tolerance of uncertainty. Clinical reasoning is the process that utilizes pathophysiology and clinical epidemiology with transforming uncertainty to certainty. Shared decision making and tolerance of uncertainty are the ones that utilize dialogue with accepting uncertainty. Currently, the concept of uncertainty has not been recognized enough in clinical practice yet, but it has been incorporated into Model Core Curriculum for Medical Education in Japan, and educational lectures and workshops have been held at Japan Primary Care Association. The Ministry of Health, Labour and Welfare has also pointed out the current situation in which Japanese people wish the public nature of medical care despite the inevitable uncertainty in medicine. This paper describes how uncertainty arises in clinical practice and raises the issue of the importance of recognizing and responding to uncertainty in clinical practice.


Key words

uncertainty, clinical reasoning, communication, shared decision making, tolerance of uncertainty