Living with uncertainty

One of the questions that doctors supposedly ask patients to test their mental orientation is ‘who’s the prime minister?’ It’s not just the terminally confused who’d have problems with that one at the moment. (Although, technically, at time of writing, it’s still Gordon Brown.)

Nothing brings out the schadenfreude quite like watching political pundits trying to sound confident and authoritative at times like these. Yesterday afternoon, commentators standing outside closed doors with microphones confidently announced that we were moments away from a Conservative/Liberal pact.

The morning after the election (gosh, what a long time ago it seems) I remember the consensus from these same pundits was that the Conservatives would form a minority government, and there’d be another election within a year. The latest talk is of a ‘Rainbow Coalition’ of what are suddenly being called ‘progressive parties’.

Clearly, none of the pundits have any idea what is going to happen. They’re on the outside of Schroedinger’s cat’s box. (Physicists: I know, thought experiment. No need to write in.) There are plenty of possible outcomes, but most of them only seem to occur to people when something unexpected happens, like Gordon’s resignation statement.

It might be unpleasant new territory for political journalists, but it’s jolly familiar to their medical colleagues, or to anyone working in evidence-based medicine. I once wrote a piece for Men’s Health magazine, to which the section editor replied with a long list of questions. Most of my answers started with the words ‘it depends’. Maybe that’s why I only wrote for them once.

People want straight answers to straight questions. ‘How long have I got, doc?’ ‘Will it cure me?’ ‘Will I get side effects?’ The BMJ’s patient information service, Best Health, tries to answer some of these questions, but we can rarely give an unqualified answer. We try to give an idea of the likelihood of something working – 8 out of 10 people said their pain was better; 6 out of 10 people feel sick while taking this medicine.

Whenever I hear someone claiming that they are still alive, despite all the doctors telling them years ago that they had only 6 months to live, I do wonder if that’s what they were really told. We like hard-and-fast answers, even if it’s bad news. We tend to screen out the qualifying bits, the ‘it depends’, the ‘in the majority of cases’, or ‘if all goes well’.

The novelist Fay Weldon, talking on Desert Island Discs at the weekend, said she was amazed that people didn’t recognise how precarious and arbitrary existence is. This didn’t make her nervous, she said; it just seemed to her indubitably true, and foolish to deny. Better by far to accept uncertainty, learn to live with it, and adapt as necessary. It seemed a pertinent point for us all this week.

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