A Way Forward

Chapter 6 concludes the book by offering a vision for how to promote uncertainty tolerance in medicine. It identifies various system-level strategies, spanning medical care, education, and research, that can foster humility, flexibility, and courage and thereby help build uncertainty tolerance into the structures and processes of healthcare. The chapter examines how these processes can ultimately enable uncertainty tolerance to become part of both the worldview of individual clinicians and patients, and the overarching culture of medicine. The chapter makes the case that uncertainty tolerance in medicine ultimately requires the adoption of a worldview that affirms the necessity and value of uncertainty, and enables us to transcend it.

Using Computational Tools to Enhance Comparative Ethnography

The medical profession has invested untold treasure in quantifying bodily processes, and excellence in the quantified biological sciences has long been the surest route to professional fame. Yet the profession also recognizes that success in the healing arts requires a grasp and appreciation of narrative and culture. Culture shapes biomedicine in at least three ways, all of which may be interrogated through ethnography. First, biomedicine has imbued the provider–patient relationship with special cultural status, and ethnography can provide insights into the nature of this relationship (which has been variously interpreted as a necessary component of a functional society, a hallmark of occupational power, or an aspect of boundary work by a knowledge profession). Second, biomedicine recognizes that health is shaped by culturally mediated behaviors that typically occur outside the clinical setting and are thus beyond providers’ immediate apprehension and control. Ethnography can provide insights into these behaviors. Finally, the scale of contemporary biomedicine (healthcare spending accounts for one-sixth of gross domestic product) has produced complex cultural institutions. Ethnographic insights are needed to characterize the organizational culture of medicine and improve the practice of healing.