3 - Uncertainty in Medicine: Through Thick and Thin

The Nocturnists

Emily Silverman

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

4.8 • 614 Ratings

🗓️ 17 April 2025

⏱️ 32 minutes

🔗️ Recording | iTunes | RSS

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Summary

In episode 3 of the "Uncertainty in Medicine" series, patient Dana undergoes a routine knee replacement and expects a straightforward recovery. Instead, she's plunged into a baffling and relentless illness—one that defies diagnosis and leaves her life in limbo. As her symptoms intensify and specialists write her off, Dana finds an unwavering ally in her primary care doctor, the one person who refuses to let her fall through the cracks.

This episode traces their year-long search for answers, revealing the emotional cost of medical uncertainty and the rare power of a clinician who stays the course. Along the way, we visit Lewiston, Maine, where a small, intentional change to residents' schedules is making the uncertainty of primary care more manageable and helping keep young doctors in the field.

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.

This episode is sponsored by a new podcast that fans of the Nocturnists are sure to love. Unleashed: Redesigning Health Care features clinician-innovators who have changed care on the front lines. Their stories, their voices, their ingenuity. Learn more at unleashedpodcast.org.

Host: Emily Silverman, MD

Uncertainty Correspondent: Alexa Miller

Series Illustrations by Eleni Debo

Transcript

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0:00.0	Listeners, if you enjoy the nocturness, then you'll also enjoy Unleashed, redesigning healthcare,
0:06.7	a new podcast about clinician-led innovation on the front lines of care.
0:11.1	The featured guests are the clinician innovators themselves, their stories, their voices,
0:15.6	their ingenuity, their commitment to their patients, and their humanity,
0:19.6	and even the deeply felt gains in their own well-being.
0:23.2	Unleashed is from our friends at the Dartmouth Institute,
0:25.9	one of our sponsors for this episode.
0:28.5	Learn more in today's show notes,
0:30.2	or search for Unleashed,
0:32.0	redesigning healthcare anywhere you listen to podcasts.
0:36.3	Support for the Nocturnist comes from the California Medical Association.
0:40.5	At the Nocturnist, we are careful to ensure that all stories comply with health care privacy laws.
0:45.4	Details may have been changed to ensure patient confidentiality.
0:48.7	All views expressed are those of the person speaking and not their employer.
0:55.2	The first time I felt like something was wrong was literally a month after I'd had the replacement done.
1:01.9	This is Dana. In 2021, she underwent a total knee replacement on her left leg, a pretty run-of-the-mill procedure.
1:09.0	Around 850,000 are performed every year in the U.S.
1:12.6	I knew it would be painful.
1:14.4	I knew it would be tiring.
1:15.9	I knew it would be swollen.
1:18.0	I knew it would start feeling better slowly.
1:21.1	I knew the incision would heal.
	...

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