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Learning to not-know

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Dec 18, 2025

Even though Ramesh has not worked for more than a decade as a physician, receiving phone calls at 3 a.m. from patients is common. “I am having chest pain,” they say. Ramesh then has to advise them on what to do next—whether they should go to the emergency room or wait until morning for a regular appointment. He sometimes loses sleep fretting about the consequences of his eventual decision, calling patients back hours later to check whether everything is fine.

Situations like this are common in medical practice because the medical field is incomplete and constantly evolving. Ramesh finds it strange that no one around him ever talked about this pervasive uncertainty. His training never included how to handle such nerve-wracking situations. Most of the time, physicians falter when symptoms fall outside their medical knowledge. Doctors often cut off any further search for answers after tests fail to show obvious proof of disease.

For example, a patient once came to me in her early twenties complaining of shock-like sensations. Her initial appointments focused only on her current symptoms, with no real effort to determine the underlying cause. After the initial tests came back negative, she was told that nothing was seriously wrong and that it was psychological. In her late thirties, however, the problem worsened, and she was diagnosed with Hashimoto’s thyroiditis. While doctors cannot fully investigate every lifestyle and genetic factor, AI can map health data onto larger datasets, whereas doctors can notice non-verbal clues by directly observing the patient.

Physicians may fear that showing uncertainty will reduce patient trust, but studies have found that uncertainties are concealed from patients in 95% of medical encounters. If a doctor cannot find an answer, it is better to tell the patient the truth—that the cause is unclear—rather than performing unnecessary procedures. Patients want honesty; they understand that doctors are human and that it is impossible to know everything.

As all human bodies are not identical, medical science can provide a general map, but it cannot reveal every detail about the individual in front of the doctor. Understanding a patient or their medical condition cannot be done instantly. To become a good physician and arrive at an accurate diagnosis, doctors should spend at least ten minutes with a patient instead of limiting consultations to just two minutes.

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