7 - Uncertainty in Medicine: A Matter of Time
The Nocturnists
Emily Silverman
4.8 • 614 Ratings
🗓️ 15 May 2025
⏱️ 33 minutes
🧾️ Download transcript
Summary
This week, we explore how time and uncertainty are intertwined in the practice of medicine. A toxicologist faces a split-second decision in the ER that could mean life or death for a young patient. A woman with chronic ankle pain spends years searching for answers as dozens of doctors offer snap diagnoses and failed treatments. A rheumatologist navigates the slow, murky waters of autoimmune disease, where diagnosis and treatment often unfold over months or years. And a couple reckons with the long-term implications of a rare and unpredictable heart condition. Through these stories, we see how uncertainty can stretch time out endlessly or collapse it into a single moment and how, in medicine, working with time rather than fighting against it is often the only way forward.
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 | Every episode of tradeoffs is grounded in rigorous research. |
| 0:03.4 | I don't think that the findings of this paper indicate that there are major clinical risks to patients. |
| 0:10.2 | Thoughtful conversations. I also was thinking that a lot of the anger, while real, is somewhat misplaced. |
| 0:17.5 | And insights into what the latest in health policy means for you. |
| 0:21.6 | And every member of Congress should be asking questions on both sides of the aisle about, |
| 0:26.2 | hey, we're spending hundreds of billions of dollars. What are we getting for? |
| 0:28.8 | We tell stories that cut through the noise, uncovering the data and personal stories that |
| 0:34.3 | help you understand the stakes and the potential solutions to health care's |
| 0:38.9 | toughest choices. Subscribe to tradeoffs wherever you get your podcasts. Support for the Nocturnist |
| 0:45.8 | comes from the California Medical Association. At the Nocturnist, we are careful to ensure |
| 0:51.3 | that all stories comply with health care privacy laws. |
| 0:57.1 | Details may have been changed to ensure patient confidentiality. |
| 1:01.0 | All views expressed are those of the person speaking and not their employer. This is the nocturness. Uncertainty in Medicine. Today we're looking at time. |
| 1:43.3 | Today we're looking at time. time. The 14-year-old girl lay pale and lifeless on the stretcher. |
| 2:08.6 | A plastic breathing tube jutted out of her mouth, and at the head of the bed, the intern squeezed oxygen into her lungs. |
| 2:14.9 | The medics said they found her down in the bathroom without a pulse. |
| 2:18.8 | The resident pushed on her chest, doing compressions. Her ribs crunched with a nauseating |
| 2:23.4 | sound of broken bones grinding against each other. When I asked the parents what happened, |
| 2:28.1 | her dad stared at me glassy-eyed, mute from shock, while the mother screamed incoherently, |
| 2:33.5 | so loudly I almost couldn't hear my own thoughts. |
| 2:36.5 | The medic handed me a can of silver spray paint. He said the patient had locked herself in the |
| 2:40.8 | bathroom 30 minutes ago. Dad broke down the door, finding her with a spray can in one hand |
... |
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