Reckoning with uncertainty to repair trust

An eager MS1 drinks from the fountain of knowledge, filling her brain with medical facts, answering multiple-choice questions dutifully, choosing the "single best right answer."An industrious MS3 proposes thoughtful courses of action in her oral presentation and gets feedback to "be more confident" and "put your nickel down."As she transitions to residency, the shades of grey multiply before her eyes, and she realizes quickly how patients "do not read the textbook."Lying awake in bed, unable to sleep, after a long day in the hospital as an attending, her brain runs through all aspects of the day where she had to navigate the stormy ship of uncertainty-how do I communicate this evolving picture to the family?How do I even begin to hand this patient off to the next provider?How do I know what I'll be walking into in the morning?Diagnostic and prognostic uncertainty are ubiquitous throughout patients' care journeys, 1 yet the dominant culture within medical education does little to acknowledge it, and even actively discourages communicating uncertainty.But falsely expressing certainty can have dire consequences, for both patients, clinicians, and the public alike.Although we can never truly take the uncertainty out of medical care, effectively reckoning with uncertainty, conveying it on rounds, and expressing it to patients and families can ultimately deepen our relationships with patients and improve trust in health care.