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How Do You Deal With Uncertainty In Healthcare?

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Uncertainty is a common experience in health care. For an upcoming book and ongoing research project, I want to be in contact with patients, families, and caregivers to find out their strategies for approaching, dealing with, and understanding such uncertainty.

For example, Ms. A. has back pain unaccompanied by underlying serious disease. She has no way of knowing whether it will go away in weeks, months, or not at all. She wants an MRI, which accepted evidence indicates will neither aid in treating her pain nor reassure her.

On the one hand, both she and the healthcare provider would like to do “something” as a sign of care; on the other hand, we want to harm neither Ms. A (with tests/procedures that won't work), nor society (afflicted by a health care system which costs too much, delivers poor care in comparison to other systems, and treats people unequally).

There are many scenarios in which treatment is pursued despite evidence showing it does not work more than placebo. For example, hormone treatment in the patient with loco regional (not metastatic) prostate cancer; repeated CT scans for thyroid nodules without symptoms; treatment of ductal carcinoma in situ (DCIS), mammograms in a patient without significant family history more often than every two years.

How do you as a patient, family member, or caregiver seek the best care in such a situation, where things are uncertain and more tests/procedures might not work? What strategies do you use? What should healthcare providers do? Please be in touch with me to help guide this work. zberger1 at jhmi dot edu

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How Do You Deal With Uncertainty In Healthcare?

  1. 1. An explorator y bioethical - journal ist ic project Zackar y Berger, MD, PhD GIM/Bioethics
  2. 2. QUEST UNDERSTAND HOW PATIENTS AND FAMILIES DEAL WITH SITUATIONS WHEN THE RIGHT TREATMENT IS UNCERTAIN
  3. 3. Uncertainty: a bridge to nowhere or a means of connection? Seeking your • Strategies • Difficulties • Obstacles • Advice
  4. 4. THE DIFFICULT CASE OF MS. A
  5. 5. MS. A HAS TERRIBLE BACK PAIN No serious underlying disease No way of knowing whether/when it will go away She wants an MRI Accepted evidence says this won’t help her pain and won’t reassure her What can she do? What can her family do?
  6. 6. WHAT’S THE BIGGEST PROBLEM? WHAT DO WE DO? On the one hand: doing something  a sign of care On the other hand: Ms. A doesn’t want to be harmed with unnecessary tests, etc. We don’t want to harm our hospital/system/society with unnecessary tests, etc. Is the biggest problem Her pain? Not knowing? Neglect?
  7. 7. ASKING FOR… Your experiences with uncertainty Your coping mechanisms Your ideas for fixes, changes, interventions Willingness to participate in focus group Please contact me! Zackary Berger, MD, PhD General Internal Medicine zberger1@jhmi.edu

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