Balancing Certainty and Uncertainty in Clinical Practice

Purpose In this epilogue, I respond to each of the five commentaries, discussing in some depth a central issue raised in each commentary. In the final section, I discuss how my thinking about certainty and uncertainty in clinical practice has evolved since I wrote the initial article. Method Topics addressed include the similarities/differences between science and clinical practice, how to teach rational and critical thinking, access to new ideas, evidence-based practice (EBP) and theory, the importance of knowledge for clinical practice, clinical expertise, and the feeling of certainty. Conclusion I was wrong about certainty and uncertainty. They are not the products of rational thought processes. Like many others, I have fallen prey to the myth of the autonomous rational mind. Burton (2008) and Marcus (2008) have convinced me that the certainty of our beliefs is influenced by feelings, emotions, desires, goals, and simple self-interest and is vulnerable to the idiosyncrasies of memory. This explains why highly rational thinkers will often reach different conclusions about the same set of observations (data). The only way to ensure scientific or clinical progress is to embrace a system that has a built-in mechanism for independent evaluation.