5 - Uncertainty in Medicine: Leaps of Faith
The Nocturnists
Emily Silverman
4.8 • 614 Ratings
🗓️ 1 May 2025
⏱️ 28 minutes
🧾️ Download transcript
Summary
What happens when doctors have to make life-or-death decisions in an evidence-free zone — and patients are left to navigate the unknown? In episode 5 of "Uncertainty in Medicine", we bring you three gripping, real-life stories: a neurosurgeon weighing impossible risks in the operating room, a palliative care doctor facing a young man's quiet resolve to die, and a patient whose long-awaited kidney transplant vanishes in a single phone call. These are high-stakes moments where instinct takes over, control slips away, and the only way forward is a leap of faith.
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 | 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. |
| 0:11.2 | 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, and even the deeply |
| 0:20.6 | felt gains in their |
| 0:21.6 | own well-being. Unleashed is from our friends at the Dartmouth Institute, one of our sponsors for this |
| 0:27.3 | episode. Learn more in today's show notes or search for Unleashed, redesigning health care |
| 0:33.1 | anywhere you listen to podcasts. 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. |
| 0:45.9 | Details may have been changed to ensure patient confidentiality. |
| 0:49.3 | All views expressed are those of the person speaking and not their employer. |
| 0:57.0 | Thank you. are those of the person speaking and not their employer. John Brush is a cardiologist who spent years in the cocoon of academic medicine. |
| 1:03.0 | Medical school, residency, rounding with teams, a fellowship at the NIH, teaching at Boston University. |
| 1:10.0 | When he made the shift to private practice, he thought he was prepared. |
| 1:15.0 | One of the things that just sort of struck me first, when you go from academics to private |
| 1:19.4 | practice, it's first of all you're working totally alone. |
| 1:23.1 | You can't lean on other people. |
| 1:24.7 | You have to deal with the uncertainty by yourself. |
| 1:29.2 | In private practice, |
| 1:34.5 | you're kind of a lone ranger out there, whereas before you were surrounded by people and dealing with it and discussing it and what have you, and it's sort of soften the edge of uncertainty. But |
| 1:39.7 | when you're in private practice alone, say, seeing a patient in the middle of the night, |
| 1:45.0 | by yourself, in an emergency room, trying to sort out what the heck's going on, |
... |
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