Uncertainty in Medical Decision Making: knowing how little you know

textabstractMaking decisions about the care of individual patients is fundamental to health care. For each patient, many decisions have to be made. In the emergency room, for example, a doctor should decide which patient to see first, decide whether an x-ray should be made of an injured ankle, and decide how this specific ankle fracture of this specific patient should be treated. Medical training is focused on acquiring the knowledge and experience to make such decisions. Other factors that are essential for patient care, including empathy and technical abilities, also involve decision making. For example, in the outpatient clinic, a trade-off is needed when one patient needs more time and empathy, but the waiting room is packed and the physician is an hour behind schedule. In the operating room, a surgeon must decide whether to proceed with a complicated laparoscopic procedure to remove a gall bladder, to convert to an open procedure, or to ask a more experienced surgeon for help.