The power of certainty: from Dr. Bernard Lown's The Lost Art of Healing

From "The Power of certainty" in The Lost Art of Healing by Dr. Bernard Lown

Effective patient management requires appreciation of the art of healing, in which one is guided by experience, by the recall of a similar case, and by the exercise of common sense. A sense of humility, too, is an asset, for any prescription or advice increasingly based on epidemiological studies of large populations. A doctor, however, confronts a single, singular individual. There is never any certainty as to where the individual fits on the normal statistical curve. Statistics may present probabilistic truth, but they shroud souls and obscure individuality.

The doctor, loyal to his or her calling, craves certainty while immersed in doubt. Yet doubt cannot delay the urgency to treat and the necessity to heal. The essence of true professionalism is to act even when the state of knowledge is inadequate. The cure needs to be prescribed immediately. The ache will not wait for the definitive study that is years away, and many clinical problems are unique, exceptional, never before encountered by the practitioner and never to be overcome by statistical battering rams. The data will frequently be soft, the patient will need to serve as his or her own control, and the cure will have to be invented if no textbook addresses the patient's precise problem. One ends up searching for the soft intangibles to substitute for nonexistent hard data. When confronting uncertainty, the physician has to be an ombudsman for the patient. But advocacy requires caring. Only then can the physician somehow surmount the agony and absurdity of human decision.

The Lost Art of Healing is available at Amazon.com.

In Practice
Date Posted: 15 December 1997