1 - Uncertainty in Medicine: The Art of Not Knowing

The Nocturnists

Emily Silverman

Medicine, Personal Journals, Society & Culture, Health & Fitness

4.8 • 614 Ratings

🗓️ 3 April 2025

⏱️ 28 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

In the premiere of the "Uncertainty in Medicine" series, The Nocturnists explore medicine's uneasy relationship with not knowing. From the clean resolutions of medical dramas to the structured rituals of case conferences, the culture of medicine often treats uncertainty as something to be avoided, resolved, or explained away. But what happens when uncertainty is not just a temporary gap in knowledge—but a constant, lived reality?

Through story and reflection, this episode invites listeners to reconsider the role of uncertainty in clinical care. What if the goal isn't to eliminate it, but to navigate it skillfully? And what if doing so makes us not only better clinicians, but better collaborators, listeners, and humans?

Find show notes, transcripts, and more at thenocturnists.org, and subscribe to our substack.

The "Uncertainty in Medicine" series is generously funded by the ABIM Foundation, by the Josiah Macy Jr. Foundation, and the Gordon & Betty Moore Foundation.

The Nocturnists is supported by The California Medical Association and donations from listeners like you.

Host: Emily Silverman, MD

Uncertainty Correspondent: Alexa Miller

Series Illustrations by Eleni Debo

Transcript

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0:00.0	12.52 p.m. Dr. House checks in. Please write that down. Do you have cable TV here somewhere?
0:06.6	General Hospital starts in eight minutes. No TV, but we've got patients. For those who don't recognize the voice,
0:11.9	that is Dr. Gregory House of the hugely popular television series from the early 2000s, House MD.
0:18.6	Poff just won't go away. Runny nose looks a funny color.
0:21.1	Patient admitted complaining of back spasms.
0:23.2	I think I read about something like that in the new English hurdle of medicine.
0:26.3	The color?
0:27.6	The fruit.
0:28.6	How orange?
0:29.6	The damn room one.
0:31.6	House is a legendary diagnostician that heads up a team of doctors that solve the medical mysteries no other doctors
0:38.1	can. He's cantankerous, he's remarkably rude, and of course, brilliant. You're talking about
0:45.8	brain surgery. I'm talking about really cool brain surgery. His name is actually a clever
0:51.2	nod to Sherlock Holmes. And like Holmes, Dr. House is fictional.
0:56.4	We know this because House solves everything.
1:00.0	All medical cases he touches are gradually stripped of uncertainty by the sheer force of
1:04.7	House's medical deduction.
1:07.5	Clue number one, if I were Jesus, curing this kid would be as easy as turning water into wine.
1:12.6	Demonic possession?
1:13.6	Close, but no wafer.
1:15.6	Clue number two, rheumatology Rhone is almost right.
1:19.6	It causes autoimmune symptoms.
	...

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